What is it doing wrong? Where are the gaps here? What is it spending money on that it should not? I cannot work it out.

I have just spotted some figures in your traffic-light system. The 12-week out-patient target is 95 per cent. The Scottish average is 61 per cent, which is shocking anyway, but in March 2024 it was around 61 per cent in NHS Ayrshire and Arran. Over the summer—in July and August—that number dropped to 35 per cent. That basically means that one in three patients were seen within the target. I have a genuine concern that people are dying while waiting for treatment. Is this costing lives?

We will ask them. Thank you.

Thank you for that comprehensive answer, which was very helpful but also very concerning. You mentioned beds in corridors, cleanliness issues, safety issues and staffing at dangerous levels. It is hard to believe that we are talking about the health service of a first-world country; the conditions that you have described make it sound like the health service of a third-world country.

However, I am keen not to scapegoat the staff in the hospitals, who, I am sure, are working in difficult conditions. Is there any evidence that none of this is the fault of the hard-working nursing and caring staff, the cleaners and the caterers—the people who deliver the services in such tough conditions? Is the problem higher up the chain?

I am sure that is true across the NHS—thank you for that.

The other issue that concerns me greatly is staffing. I deal with a lot of casework from that part of the world, particularly related to Ayr hospital and Crosshouse hospital. My understanding is that Unison, which represents many of the staff there, has surveyed the staff and that the outcomes are worrying. The last statistic I read in the Ardrossan & Saltcoats Herald was that 32 per cent of NHS Ayrshire and Arran staff felt that they are so short staffed that patients’ lives are at risk. That is nearly one third of the workforce.

Those staff are working in an environment where they are struggling. The board is spending huge amounts of money on agency staff to fill in gaps at both a consultant level and a nursing level. That is costing huge amounts of cash, while the staff themselves are frustrated because they cannot deliver the quality of service to their patients that they think they need to—and ultimately that is putting lives at risk. We are not just talking about numbers; we are talking about people’s lives. What evidence is there that the board is taking the issue seriously or doing anything about it?

Is any of that a surprise to anyone? We know that there is an ageing population, particularly in this health board area. Demographic analysis has been done—using data, presumably. It would not have been a new problem, but would have been known to the board and, indeed, to ministers for some time.

The idea that it is a surprise that lots of people who are elderly and unwell might present at A and E—setting aside the issue of Covid or an unexpected health issue, which clearly people were not prepared for—seems surprising; I am surprised that this is a surprise to people.

That leads nicely into what the solution is. Is it just throwing more cash at the problem? Is it the end-to-end fixing of all the problems that response times for A and E, bed-blocking and delayed discharge present? Do we need more staff? How do we solve these issues? You can either write cheques endlessly to health boards or have a systemic root-and-branch review of the entire journey from being ill to getting home again.

I will come on to outcomes later—it is an interesting area that we have not covered. I want to go over some ground that has already been covered around sustainability and finances, which are important issues—we are the Public Audit Committee, after all.

The bottom line is that we have heard a lot of numbers and it is very difficult to forecast how much the benefits will cost, how much the block grant adjustment will cover—whether it will cover all or some of that cost—and, indeed, what take-up levels you will get in real time as time progresses and things stabilise. There are a lot of known unknowns there.

However, the bottom line that I think that we all agree on is that the Scottish Government is spending more on social security than it receives. I think that that is a given, and it is forecast only to increase. No matter who you ask, they will tell you that that number is going up. I think that there is a valid question in here. I am not criticising the nature of the devolution of the benefits system but, at the end of the day, ADP is a so-called “fully funded” expenditure in the Scottish budget, so the money has to come from somewhere. I have a question for the Scottish Government. How on earth is the Scottish Government supposed to make ends meet and balance the budget, given that, according to all the forecasts and as Mr Beattie pointed out, the cost of the benefits will increase exponentially over the next five years?

Okay. I will quickly cover off two final areas, one of which is fraud. Obviously, the DWP has been around for a very long time, so there is a substantial amount of fraud in the system—we all know that, and I am sure that it tries its best to deal with it. However, Social Security Scotland is a new entity and it is fully funded by the Scottish taxpayer; therefore, there is an expectation that Social Security Scotland will take the issue seriously. I appreciate that it is at an early stage, but what evidence do we have of any fraudulent activity within devolved benefits? What has been done to tackle it and to prevent it?

Yes, there will be, but let us be honest: Social Security Scotland was hugely expensive to set up. I would have thought that the tools required to identify fraudulent activity would have been at the core of the start-up costs of the operation. It is disappointing that an Audit Scotland report has identified that those tools are not there.

My final question is about operational costs. What are you doing to keep them down? The cost of delivering the system, before you even put a penny into someone’s bank account, is hundreds of millions of pounds per year. That is obviously of concern to the Public Audit Committee.