That is very helpful. I will develop that theme a little bit. There is the question of innovation. It comes back to the fact that it is not just about the money but about how we do things. You cite in the report a couple of examples of innovation. One of those—the NHS 24 system—is a bit more long-standing and structural. It has been reviewed and reformed.

There is a case study in the report about the Scottish Ambulance Service intervention. I think that you said that it has established an integrated clinical hub to introduce a level of clinical judgment to determine whether, where there are calls for ambulances to attend, a reasonable demand is being placed on the service. The finding that the Scottish Ambulance Service supplied to you was that, when interventions were made, it was discovered that up to 50 per cent of the calls did not require a 999 ambulance. That result is based on intervention in 15 per cent of calls. Will you reflect on that? If there were a greater level of intervention so that more calls were screened or had that clinical judgment applied to them, would that lead to the same kinds of results right across the entire service?

Thanks. Another area mentioned in your report is NHS 24 interventions. By the same token, how effective have they been? Is NHS 24 revising the way that it works? Is more investment going into it, particularly given the Covid-experienced environment that we are now in? The delivery of public services is viewed slightly differently, is it not, in light of what had to happen over the course of the pandemic? Can you enlighten us on the NHS 24 changes or interventions and how effective they have been?

Okay. Obviously, we are talking about people, but, from an audit point of view, the unit cost to the health service of agency staff is considerably more than the cost of a direct employee, is it not?

Yes, absolutely. I am sure that we will return to that point.

I will move things on and turn to something that has been of interest to the committee, not only in this but in the previous session, and that is the financial position of individual territorial health boards. In the report, you suggest that, in your assessment of the 14 territorial health boards, only three are expected to break even, which means that 11 are not. I presume that that does not mean that they will make a surplus, but that they face a financial deficit. We know that, in the past, that led you to have to produce section 22 reports about health board conduct, because concerns were raised about the routes that people chose to go down to get additional resources.

How fit for purpose are the brokerage arrangements? The term “brokerage” is about an intervention by the Scottish Government to help out individual health boards. At one point, I think, it was based on a one-year time horizon; it then went to three years. Will you bring us up to date on the current position and say whether, in your estimation, those arrangements will be robust enough to get the health boards through the challenges that they face?

Good morning. I welcome everyone to the 10th meeting of the Public Audit Committee in 2023.

The first item for committee members to consider is whether to take agenda items 3, 4 and 5 in private. Are we agreed to take those items in private?

Members indicated agreement.

The main agenda item is consideration of the Auditor General for Scotland’s report on the national health service in Scotland in 2022. It was released exactly one month ago today. We are pleased to welcome the Auditor General for Scotland, Stephen Boyle, to give evidence on that report. He is joined by executive director, Antony Clark; senior manager, Leigh Johnston; and senior auditor, Fiona Lees; all from Audit Scotland. You are all very welcome.

We have a large number of questions to put to you on what was an impactful report. Before we ask those questions, the Auditor General will make a short opening statement.

May I clarify something that probably stems from my ignorance? On the one hand, you talked, and I asked a question, about the increase in resources—an additional £4 billion over the past five or six years—but, on the other hand, the narrative in paragraph 24 of the report is about how health boards have to make savings. Can you reconcile the two for me? A record level of public money, £19 billion, is going into the national health service—not into the broader category of public health but into the national health service—yet, at the same time, there is a call on national and territorial NHS boards to make savings.

Presumably, you will also keep an eye on how that fits in with net zero targets and that whole agenda of how the public sector estate needs to be changed quite substantially to meet our ambitious goals for reducing carbon emissions.

The NHS is a very high priority for all of us in the Parliament and I reflect that the terms of our debate about it often contrast inputs and outcomes. Your report notes that there has been a £4.4 billion increase in NHS spending since 2018-19 and that the budget for 2023-24 is estimated to be over £19 billion. You assessed that level of expenditure as being three years earlier than anticipated. There is no question that there is substantial public investment going into the NHS, yet we do not necessarily see outcomes improving. The rather fundamental question is, do we just need funding or is it necessary to apply other factors in order to rise to the challenges that we are facing in the national health service?

That is fine. We will, I am sure, return to those issues in subsequent sessions on the NHS.