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Chamber and committees

Meeting date: Thursday, April 28, 2022

Public Audit Committee 28 April 2022 [Draft]

Agenda: Decision on Taking Business in Private, Section 22 Report: “The 2020/21 audit of NHS Highland”, Section 23 Report: “New vessels for the Clyde and Hebrides: Arrangements to deliver vessels 801 and 802”


Contents


Section 22 Report: “The 2020/21 audit of NHS Highland”

Our first evidence-taking session this morning is on Audit Scotland’s report “The 2020/21 audit of NHS Highland”. First of all, I welcome to the meeting Rhoda Grant, who is joining us online for this and the next item. I also welcome, via videolink, our three witnesses from NHS Highland. They are Pamela Dudek, who is its chief executive; Boyd Robertson, who is the chair of the board; and David Garden, who is its director of finance.

I remind everyone, including committee members, that we are very tight for time this morning, so I would appreciate short questions and short but incisive answers. To begin, I invite Pamela Dudek to make an opening statement.

Pamela Dudek (NHS Highland)

Thank you, convener, and good morning, everyone. Our chairman will actually give the opening statement.

Madainn mhath. Good morning from Inverness. Thank you for the invitation to meet the committee to discuss NHS Highland’s annual accounts for 2020-21 and the section 22 report.

I begin by acknowledging the extraordinary efforts of our health and care teams, our managers, our patients and our council colleagues in responding so magnificently to the pandemic’s manifold challenges. The commitment, professionalism, empathy and compassion that our teams have shown over the past two years have been truly remarkable and impressive, so I place on record my sincere thanks and admiration for the work that they have done, and continue to do.

I took over as chair of the board just a year before the pandemic struck, and Pam Dudek, who took up the chief executive post in October 2020, has yet to experience a period free of Covid in her role. Despite leading the organisation in such highly unusual and demanding circumstances, I am pleased to report that NHS Highland has made huge progress in addressing the issues that led to the board’s escalation to level 4 on the Scottish Government’s ladder of escalation. That has been acknowledged in the section 22 report, and it was recognised in the board’s de-escalation to level 3 last year.

The organisation has made major advances in addressing a transformation agenda that covers culture, finance, performance, governance and leadership. Board governance has been greatly enhanced through measures including strengthening of the board assurance framework, a revised committee structure and bimonthly integrated performance and quality reporting. Both the executive and non-executive arms of the organisation’s leadership have been radically revamped, and we now have a very strong board in place.

Many positive actions have also been taken to improve the organisation’s culture in the close to three years since publication of the Sturrock report. Those measures include the establishment of the culture oversight group, the appointment of an independent external adviser, a listening and learning staff survey and panel, a leadership training programme and the establishment of new employee services such as the guardian service and the employee assistance programme. One of the most significant initiatives has been the healing process, which was co-produced by whistleblowers, staff side and our human resources team.

The second major challenge that we faced was our financial performance in the years up to 2018, when a sizeable financial deficit that had accumulated resulted in the need for brokerage from the Scottish Government. A three-year recovery programme was put in place in 2019 to bring the board’s finances into balance. Significant headway has been made on tackling the original deficit, and much of that progress can be ascribed to the work of the programme management office, which has been embedded to direct and drive cost improvement opportunities. A number of revised financial governance arrangements, including the formation of a financial recovery board, have also been contributory factors.

By the end of financial year 2019-20, we had fully achieved our substantial savings targets, with 56 per cent being made on a recurrent basis. Our year-end outturn exceeded our financial plan and our brokerage requirement was lower than the approved target. We had planned to deliver similar financial performance, with reduced brokerage in 2020-21, until the pandemic intervened and severely impacted on our ability to enact the full savings programme. Nonetheless, we managed to achieve significant savings when other boards struggled to do so. The financial turnaround, which has continued in 2021-22, has been a tremendous achievement and is the result of a huge amount of hard work and endeavour by our clinical and management teams, our finance staff and our programme management office.

I can say with confidence that NHS Highland is now in a much stronger position than it was and that it is well equipped to deal with whatever challenges lie ahead. Our chief executive Pam Dudek and our finance director David Garden will join me in answering the committee’s questions.

Thank you for that opening statement, Mr Robertson. It sets the scene very well for the questions that we have. I intend to direct my questions to Pam Dudek as chief executive and, therefore, accountable officer, but she might in turn refer them to Mr Garden or you.

You touched on NHS Highland’s financial position, which was one of the reasons for the section 22 report being required in the first place. I think that there were three consecutive years in which the in-year financial balance was in the red. In your opening statement, you highlighted the extent to which savings are required; from my reading of the Audit Scotland report, those savings are of the order of £32.9 million.

My opening question is about the progress that has been made. Where are things now financially with NHS Highland? Do you consider the board to be on course to make the cost improvements and savings that were identified, and how have things been affected by Covid? I will come to Pam Dudek, first.

As you will appreciate, we are having to manage our finances in what is a very volatile environment. To our credit, we have kept our PMO going throughout the pandemic; indeed, despite the pressures, the interaction in that respect has been significant. As you will see and as you have recognised, the pandemic interrupted what was a very clear and worked-out programme of savings over the past three years, so we have faced challenges in achieving the full intent.

In the here and now, the volatile environment remains a challenge for us and will, as it will for other boards, continue to be so, as we move forward. However, I believe that we have a very strong methodology, with significant buy-in across our organisation.

The cultural aspect of the matter is also important, because the message has been a bit mixed over the past year and a half. We have been dealing with the pandemic and additional funds have come in, so we have had a contradictory discussion with our teams about their needing to spend to deal with the pandemic while needing to save to help our underlying deficit and get us to the right place.

We have a fair degree of confidence that we are able to make significant savings. I have already started the process for the year to come, but we have a lot of work to do if we are to be successful in that. Like other boards, we believe that we will be challenged in that space. Dave Garden can come in and talk a bit more about that, if that is helpful.

Yes. Mr Garden—please come in.

Good morning, everybody. As Pam Dudek said, the challenges that we have faced in the past two financial years as a result of the pandemic have meant that, like other boards, we have not been able, without financial contributions from the Scottish Government, to deliver the level of savings that we needed to break even.

As was mentioned, our target for the year that just closed was £32 million. However, we fell short of delivering those savings by about £12 million. That sounds really negative but, in fact, during the pandemic, we delivered £20 million of savings at a time when people were really busy dealing with other more important things. We need to celebrate the facts that we still delivered those benefits and that we have processes in place that allow us to continue to do that. However, we also need to recognise that it has been a really difficult couple of years for delivering savings. NHS Highland, like most boards in Scotland, faces a fairly significant financial challenge in this financial year.

With all the savings and cost improvement programmes, there is the question of what effect that work is having on the level of patient care and the services that you deliver. Is there an adverse effect in order to achieve the challenging targets that you mentioned?

A really important stage of the cost improvement work is to quality assure the decision making and to examine the impact that proposals for savings would have on care and treatment. We have a safeguard that sense checks that. To date, because we have that safeguard, I have not come across anything that has given me significant concern about the decisions that have been taken.

The real challenge is that, obviously, we have to balance our books and have good governance around that, but we must also consider the reform agenda. It will not be possible to keep slicing out savings. We have been trying to think about change and innovation that will help us to balance our books but will not compromise the quality of care. From my perspective, that is the key focus that we must maintain and build on if we are to be successful and not bring about that compromise. We have challenges outwith the finances in terms of maintaining the level of care and treatment that we wish to offer. That relates to the workforce.

Thank you very much indeed. Colin Beattie has a series of questions that he wants to put to you.

My questions are mainly about governance and succession, which, in the past, have been serious issues in NHS Highland. What progress have you made in your first round of succession plans? My understanding was that your first meeting on that would take place in December 2021.

[Inaudible.]—board established. However, as you will be aware, the past few months from December have become pretty hot in the system, so our ability to formalise that has been compromised somewhat and we have set a later target of October. All last year, we spent a lot of time looking at our management structures, succession and the challenges that we had from what had gone before. We have had quite a successful year in terms of bringing in new people from various parts of the country and securing some of our really important posts. We had a really good level of attraction to those posts, so we had good fields to choose from, which is clearly important.

09:15  

At the moment, we are really trying to pin down the appraisal process and the personal development plans in the first three layers of leadership and management. I am talking about managers and clinical leaders and the succession framework that will take those people into the right space to be fit to lead in the future, which perhaps requires a different set of skills from those that were traditionally required. We are definitely seeing more interest in our posts. We have successfully brought in people with really good credentials to very senior posts and we will build on that from now. We have also introduced a leadership and management course that will run through the top four layers of management and leadership, with the succession plan in mind.

Moving on from that, what actions has the board taken to address the Sturrock report findings and to foster a much more open organisational culture?

I know that we have to be succinct, but I could spend a lot of time talking about that, because we have done a huge amount of work on that, which we have reported regularly on at our board’s public sessions. Many papers have been written on all the actions that have been taken forward.

That is very connected to the culture programme that was established and has consolidated the actions that were required of the board into one programme of work. We have done the requested culture survey of services in Argyll and Bute.

We have also brought in an external guardian service, which is coming to the end of its second year and going into its third year, which is the extent of its contract. That has definitely given people a safe place to go and raise concerns, many of which are resolved on the first contact. Concerns that require further action are raised with management, or the guardian service will provide a service in a team or with an individual.

We have also implemented our whistleblowing standards, which relate very much to that agenda. Our whistleblowing champion goes out and is visible and his visits are advertised. That is another confidential and private way for people to come forward if they cannot raise their concern within the organisation.

In answer to the question about whether we have an open and transparent organisation where people can feel free to speak up, that comes down to me and the tone that I set, and to the management and leadership of the organisation. I have worked hard with my executive team and middle management to reinforce the style and approaches that we should have, so that people are encouraged to speak up and share their ideas. The health board is a people organisation, so it is always challenging to make things in that space 100 per cent bulletproof; it is a work in progress and it will continue.

On the back of what you have been saying, could you indicate where you believe the healing process is at this point?

We are just concluding the healing process; 271 people have gone through the process and been supported through psychological therapies, a payment or a bespoke apology from me, as well as other actions that have come from their interaction with the independent panel. The healing process has also generated learning reports. There is consolidation of the learning themes. That relates to the Sturrock report and our culture programme and whether we are addressing all the issues that have been raised historically and in the here and now.

Can you briefly indicate what actions the board has taken to review and refine the board risk assurance framework? That question might be for Pamela Dudek or for the chair.

Pamela Dudek

I think that Boyd Robertson is looking to come in. I am happy to hand over to him or to continue.

Absolutely—if Boyd wants to come in, he can talk about that.

I first want to go back to a previous question about the strengthening of the board and the executive arm. We appointed seven executives in the year in question, and we have had a further tranche of 15 senior management appointments in the year that has just ended. That is one indication of the way in which we have strengthened our operation.

We have also strengthened the board. We had four appointments of non-execs in the year in question, and a further one last year. Last year, we co-opted to the audit committee a member with particular skills, and we are extending his role on the committee in answer to points that were raised previously by your committee.

Already, 31 of the 35 recommendations in the Sturrock report have been enacted. Pam Dudek has referred to a number of the actions that have been taken. We have an important four-level leadership and management development programme, and we also have a courageous conversations training package, which has been delivered to more than 1,000 colleagues in the organisation. That is a significant number.

Risk assessment comes under the aegis of our audit committee, which has been strengthened. Our internal audit arm has created a programme of inquiry into aspects of how we handle risk, and we have taken several steps towards improving our risk assurance framework.

I ask Pam Dudek to say a little more about the precise steps.

We have done a huge amount of work on our risk framework, but it is fair to say that, as a board, we still want to do a bit more. A framework is in place, and we are working on how we state our risk appetite and tolerance in the months to come. That will become much clearer as our strategy emerges; we are working on our longer-term strategy at the moment.

We now have a clear risk register and a much better rhythm around how that is reported and set up to go through our board committees. The register can also be added to, if anything from the board committees needs to be added in. That is reported up to our board meeting, as you would expect.

Within that framework, we have an assurance level that is reported at committee and at the board. That relates to risk and being able to draw assurance and justify the assurance level. There is a four-level framework—from substantial assurance to not being able to draw assurance—for managing risk.

We have come on significantly from when I joined the organisation, but it is fair to say that it is an improvement journey, and we spend a lot of time refining, improving, understanding and looking at other good practice to get ourselves to the optimal space.

I have one last question. An issue that did not really come up in the report was Raigmore hospital. For years, it has appeared as a sort of problem child, for which costs were significantly higher in areas such as prescriptions and, I think, consultants. What progress has been made to reduce costs in relation to Raigmore?

There are two big areas, one of which is prescribing, which you mentioned. Cost improvement activity has looked at high-cost drugs and has resulted in significant savings of £2.5 million in three years.

The other area is locum costs. As you know, we have had hard-to-fill posts. We still have such posts, but we have brought our decision making about locum arrangements in house and put a process around that, which has resulted in a reduction in the costs. David Garden can give you the figures on the Raigmore hospital spend.

We are operating acute services as a one-hospital, four-site arrangement, so that we can optimise our rural general hospitals. You are probably aware that staffing in our rural generals remains a challenge, which leads to high locum costs to maintain services there. That is on our reform agenda; it needs to be addressed and we are looking at it.

In the year of the section 22 report, Raigmore hospital was in a more managed space, if you like, and it will remain so but, like any acute hospital, it has on-going challenges, such as the increasing costs of new technologies. Our challenge will be to try to build those into our budget and prioritise as appropriate. The teams there have bought into the cost improvement methodology. As I said, we will reinforce that and do workshops with them to get back on track now that things feel that they may be easing.

Sharon Dowey has a couple of questions that follow on neatly from that.

I will ask about workforce challenges. Previous section 22 reports highlighted that NHS Highland needed to address its reliance on locum and agency staff to achieve long-term financial sustainability. Covid-19 pressures have increased the board’s requirements for locum and supplementary staffing and have delayed plans for the development of the attraction, recruitment and retention strategy. Nonetheless, the board has made progress in recruiting permanent medical and nursing staff. It has filled 21 hard-to-fill consultant positions, including in the rural general hospitals that you just mentioned, as well as 62 newly qualified nurses and midwives. The board also took the management of locums back in-house in October 2020 to better control spending and rates.

Can you tell us a bit more about what actions the board is taking to reduce reliance on locum staff?

The recruitment strategy is key to that issue. As you will understand, the national picture is one of a competitive market and reduced availability of what we are looking for in many quarters. We have done a bit of work on recruitment, and we have a national treatment centre to deliver, which requires additional staffing, so there are a few different things.

We are actively working to be present in a full-on way at job fairs wherever we can. We have been looking at different ways to advertise and attract people, and at how we onboard and assist people to come to the region. You will be aware of the challenges of finding accommodation and getting settled, particularly since the pandemic began. We are trying to consider all aspects of recruitment and be diligent and enthusiastic in our approach, and we have seen signs of that paying dividends.

We have been careful to consider our expansion in relation to the national treatment centre, and we have made an integrated people plan, because there could be a danger of undermining Raigmore hospital by having them as two separate centres. We have worked hard with the clinicians and teams there to make that an integrated model. For retention purposes, that gives a nice portfolio for people and a bit of diversity while keeping it a team game. We are considering all ways of attracting people; we are involving communities to try to sell areas, particularly the remote and rural ones. As I said, we have put in place a bit of a marketing strategy with regard to recruitment and retention.

09:30  

Obviously, looking after the staff that we have already will be key. They have been through a tough time but, when I go out and about, I am always hugely impressed by their level of commitment, enthusiasm and keenness to get to a stable place. We need to support the staff that we have, but we are also being fairly proactive in different ways in trying to recruit new people.

We have also engaged with recruiting internationally, and we are exploring partnerships on an ethical basis with other countries.

You have covered my next question, which was about what the board has been doing to attract, recruit and train the workforce needed in NHS Highland. Have the processes that you have put in place been enough to encourage people to stay in their positions? You have said that you have recruited 21 hard-to-fill consultant posts and taken on 62 newly qualified nurses, but have you managed to retain all of them? In our previous evidence session on this report, I asked whether the pandemic was having an effect on keeping staff, given that people were restricted from moving around. Now that restrictions have loosened, have you seen any change in that respect?

Yes, we have seen a bit of an increase in turnover, and we are trying to analyse and understand what lies behind that. It is not necessarily a case of people moving on; it is also about the demographic of our workforce, about 27 per cent of whom are over the age of 55. We definitely know of people who have decided to retire and return on a part-time basis with us or to retire completely as a life choice. Equally, though, there are people who have chosen to move away from the cities and to come and work in NHS Highland for a better work-life balance.

We are keeping a close eye on the matter. As you have said, turnover came down significantly during the pandemic, but it is now on the increase again. We are looking at that closely across the professions and are seeking to understand what we need to do to mitigate things.

Thank you.

I think that Boyd Robertson wanted to come in but, given that we are pressed for time, I will bring in Craig Hoy. If Mr Robertson still wants to say something after Craig Hoy’s questions, I will see whether we have any time for that.

With regard to retention, can you tell us briefly about the exit interviews that you carry out? When someone leaves NHS Highland, what do they typically say is their reason for leaving?

That is a good question. Historically, that area does not seem to have had the value placed on it that it might have had, and we have had to pick it up and put a process in place.

We do not have a high degree of formal feedback, and that is the process that we are trying to implement. What we have is anecdotal—we are trying to build up the data set so that we can be much clearer about this—but, from what people have said to me, the reasons are varied. People are definitely making life choices as a result of their experience of the pandemic; indeed, I have come across a number who have decided to go on that basis. Retire and return has offered us an opportunity to negotiate with some people and get them to stay with us to help with, say, vaccination programmes and so on. I have also had feedback that some people have left because of the historical arrangements and the difficulties that they have experienced, but those are isolated cases.

However, we need to improve significantly in this area and get a much more robust database. I am sorry that I am not able to give you good and robust data, but we are in the process of implementing that framework.

That is critical, and the issue appears to be common to other health boards, too. If we are having a recruitment and retention crisis, it is vital that we capture the reasons for people leaving the profession.

What efforts are you putting into the creation of a more sustainable workforce model and dealing with the fact that you are competing all the time with other areas of Scotland that might not have the same rurality or cost of living issues? What more could the Scottish Government and NHS Scotland do to support health boards such as NHS Highland that cannot compete equally with boards in other parts of the country?

One issue that I have raised nationally is that we need support with international recruitment. As a nation, we are at the start of that process, and we need to go at a slightly faster pace and build it. I do not see that as the cure for all, but it is important.

Another issue relates to the wider community planning partnership agenda and how we can work much more diligently, firmly and in a connected way with our communities to support the economy and to provide careers for people and ways in which they can grow, perhaps without leaving their locality. We are doing quite a bit of work on that in the Highland Council and Argyll and Bute Council areas, although we are a bit further ahead in the Highland Council area, where we are investing with partners and strengthening the community planning approach. We have nine community planning groups, with us as an anchor organisation, and the focus is on trying to create jobs. The benefit for us is that we get local people working for us, particularly in the care sector and through routes into nursing. We see that as being as important as focusing on international recruitment.

Another important aspect is the difficulties with accommodation down the west coast. We have been working well with our council colleagues and housing associations on that, but the level of affordable and permanent stock available versus the pace at which we need to bring in people creates a challenge. We have mobilised a lot of actions on that, but we could do with anything, on a national level, that could help us.

People talk about a weighting. That does not exist at the moment but, for our rural general surgeries and some of our island ones to survive, we need an offer that brings in people and supports them from a social and welfare perspective, and with a professional portfolio that keeps them dynamic and motivated.

Those are some of the areas that are trickier for us. We can create profiles and work with NHS Education for Scotland and the universities to try to get more local courses, but we would appreciate anything that supports us at a national level. You are right that we compete with bigger health boards that might be more attractive for someone’s portfolio or easier to join than is the case with NHS Highland. That applies on the west coast, in particular, but the situation in Inverness is extremely challenging as well.

The next questions are from Willie Coffey. Willie, over to you.

Thanks very much, convener, and madainn mhath to the panel from NHS Highland. I start by reminding everyone that when a health board comes before the Public Audit Committee it is usually because of Audit Scotland knocking on the door and this Scottish Parliament committee having a look at matters.

To your great credit, you appear to have turned your finances around. However, my question is, how can there be such a transformation on finances with no impact on healthcare, or the public’s perception of it, in NHS Highland? You said that nothing of significant concern resulted from that. If you do not mind, please tell us how that can be.

The formal decisions that we take to make savings go through a five-stage process, and one of those stages—which takes place before a decision is signed off and considered viable—is when our clinical director of nursing, medical director and other clinical leads review it and advise on the associated risks. We look to them to provide recommendations and support and set out the risks so that decisions can be taken collectively.

Over the past couple of years, the workforce challenge has presented a bigger risk than our finances. At times, the deficit in nursing in particular, and in some of our hard-to-fill consultant posts in areas such as psychiatry, will have felt precarious for the public, but that situation has resulted from workforce supply issues rather than an effort to make financial savings.

I think that we have the right diligence in place around what we are doing. Looking forward, we have to change and reform to deliver services differently. That is not news, and we need to do it not just for financial reasons but in order to be sustainable. It will be really tricky, which is why it is important that we work with communities so that we have a clear understanding of, and joint agreement on, what is tolerable and what is not, and so that we can escalate matters if we are in a position where we have make a difficult decision that would compromise care. I would hope that we would never get to that point, but it would involve a discussion with the public and with our workforce. We are used to clear models of operating, but we are not going to square the bottom line unless we can think of different ways of working.

Do you engage directly with the public? If you are saying, “We used to spend all this money on delivering this care and we no longer do that”, does that have an impact, or are you still able to deliver the same level and quality of care through the transformation process that you have embraced as a result of the Audit Scotland report and the Public Audit Committee’s interest in the work that you do?

It is getting more difficult, which is why we have to push further on what reform looks like. We engage with the public, but we could still do that much better than we have done historically. We have engaged, or tried to engage, extensively with the public in developing our new strategy, and we will continue to do so.

As is often the case, the level of engagement is variable, unless it involves a very specific matter, but we are really going to try to improve on that because we need a shared understanding. Communities can come up with solutions—we have only to look at our experience through Covid of communities mobilising to help us through a strengths-based approach. I still believe that a lot of our improvement and answers will lie in working with communities so that changes do not come as a surprise and do not feel as if they represent a downgrade in services. We need to continue to try to do that well, but we still have a way to go in that regard.

We have to have difficult conversations about how we change while retaining quality, as that has to be at the heart of everything that we do. Our clinicians will not buy in to anything else.

Looking ahead, are you confident, and can you give the committee an assurance, that you can continue to make the savings that you are making and that, after the pandemic, you can continue to deliver the quality and level of care that the public in the NHS Highland area expects?

We have in place every system, process and governance arrangement to ensure that that happens. I caveat that by saying that we are working in a hugely volatile world—I have been working in health and care in the NHS for 40 years, and I have never led or managed a team in a situation that is anything like the one that we have been in.

With the caveat that there are some things that are outwith my control, and the fact that we are not on a straightforward journey, I think that we have the diligence and the framework in place to do the best that we can, which will always involve trying to ensure high quality and efficiency and high performance throughout our organisations. However, we can probably only do that, and provide assurance, in respect of how we get on with our transformation agenda and strategy, which is all currently work in progress.

We are a strong organisation with some real innovators and some really good leadership. We are also a changing organisation in relation to how we connect communities, all of which gives me hope, as a leader, that I can take us to the right place.

09:45  

Thank you for that, Pamela. That is very encouraging. Tapadh leat.

We have only a couple of minutes remaining. I mentioned at the start that Rhoda Grant joins us this morning. Do you have any final thoughts or questions to put to the panel from NHS Highland, Rhoda?

Thank you. I will try and be as quick as I can.

At the start of the process, the NHS Scotland resource allocation committee—NRAC—settlement was not paid in full to NHS Highland. Is that the case now? In relation to the challenges coming down the road, obviously, there is Covid recovery, but there is also the taking on of maternity services on behalf of Grampian for Moray until Dr Gray’s hospital is restored. You also talked about the elective centre. How will you cope with those challenges, and are you receiving the funding that you require in order to deliver for the people of the Highlands?

I will ask David Garden to come in to say a bit more about the NRAC settlement. However, in brief, we agree with Rhoda Grant that we were not in parity at the beginning. The committee will know that we got a significant uplift last year to bring us up to a reasonable level of parity with other boards.

In relation to maternity services, for me, the most important thing is that NHS Highland’s maternity strategy is secure and clear and worked up with the mums and families of Highland. As the committee knows, we have our own challenges in house in relation to that.

In relation to the Moray maternity aspect, I have been very clear that we cannot do that without the upgrade to our unit and without the revenue costs to enhance staffing, which we would need in order to be able to do that in line with the quality and safety agenda that would need to prevail. We are going through a planning process at the moment and doing due diligence around what that would look like. That will come. As a board and as a chief executive, I have been very clear that we will work through how we will do that and what it will take to do that. We are trying to do that between now and June.

We are also considering the concerns of our clinicians and making sure that those red flags are fully explored and that we are clear that they are not barriers—and, if they are, why they are. We are working through that well, but we are absolutely coming at it from an NHS Highland maternity strategy perspective. We have to do that. Nobody knows that more than yourselves and the Caithness mums and the mums across all our far-flung places who have a tricky choice.

The national treatment centre is funded and the staffing model is funded. Again, I feel that our biggest risk is in relation to staffing and our being able to attract and retain. That takes us back into accommodation and onboarding, which we will take ownership of and do everything that we can in relation to. That will be our biggest challenge. However, we are making reasonable progress, and the next three to six months will tell us how well we are doing.

For a number of years, the Government commitment has been that boards that are below their target share—that is, that are getting less than what their target share is—would be maintained within 1 per cent of that share. We have been below 1 per cent for a few years now, which resulted in a fairly significant uplift in the previous year of about £14 million. In addition to that, in the year that we have just started, an additional £3 million of NRAC parity money was given to us in order to maintain us at that level. Right now, I think that we are at about 99.5 per cent of our NRAC share, which is about £3 or £4 million below.

Rhoda, do you have any further questions?

No. Thank you for letting me attend the meeting, convener.

That brings the evidence session to a close. I thank Boyd Robertson for his opening statement, which was very useful in framing our session. I thank David Garden, director of finance, for his input, which has been valuable, and I particularly thank Pam Dudek, the chief executive, who has fully, comprehensively and candidly answered the questions that we put to her.

We will suspend briefly to allow for a changeover of witnesses.

09:50 Meeting suspended.  

09:52 On resuming—