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Public Audit Committee
Meeting date: 4 May 2023
Craig Hoy
The Scottish Government’s initial commitment was to introduce a national care service in the lifetime of this parliamentary session. It now seems that its commitment is to legislate for a national care service in the lifetime of this parliamentary session. For clarity, what timetable have you been instructed to work towards?
Public Audit Committee
Meeting date: 4 May 2023
Craig Hoy
Would it be fair to say that, at this point, you are not doing enough to capture the information on why people are leaving?
Public Audit Committee
Meeting date: 4 May 2023
Craig Hoy
I want to follow up on the deputy convener’s question on staff retention. Last year, I attended a round-table meeting with the Royal College of Nursing, the chief nursing officer for Scotland, the former Cabinet Secretary for Health and Social Care and front-line nurses. One thing that struck me was that simple but, I presume, effective mechanisms such as exit interviews were not necessarily being routinely deployed throughout the service. Perhaps I could have confirmation that you now use such tried and tested practices more. Do you have an adequate handle on why people are leaving nursing, for example? How responsive are you to the key messages that you get about why people leave the service?
Public Audit Committee
Meeting date: 4 May 2023
Craig Hoy
I have received correspondence from a constituent who has had to borrow money from their children to have a hip operation. That is unacceptable, but surely you can understand why people are choosing to do that in very challenging circumstances.
Public Audit Committee
Meeting date: 4 May 2023
Craig Hoy
I accept that. However, the draft minutes of that meeting say that somebody gave the
“green light to present what boards feel reform may look like”.
Fundamentally, they say that
“areas which were previously not viable options are now possibilities”.
What are those viable options?
Public Audit Committee
Meeting date: 4 May 2023
Craig Hoy
The financial memorandum that accompanied the bill identified costs as being somewhere in the region of £1.3 billion, although that has been contested. The Auditor General said that he could not come to a final conclusion as to whether that number is accurate. Is there a concern that, if the total cost of establishing and operating the national care service—if it comes to fruition—is higher than that, we will end up cutting into health expenditure as a result?
Public Audit Committee
Meeting date: 4 May 2023
Craig Hoy
Good morning, Ms Lamb. The Scottish Fiscal Commission’s fiscal sustainability report that came out last month raised serious concerns about future financial pressures on the NHS in Scotland. It identified that those pressures are due not only to an ageing population but to rises in chronic health conditions and the technological advances that are moving us forward. What are you and the NHS in Scotland doing to plan for those future financial pressures to ensure that Scotland’s NHS is financially sustainable?
Public Audit Committee
Meeting date: 4 May 2023
Craig Hoy
That is a long-term sustainability issue. In relation to the shorter term, the leaked draft minutes of a meeting of NHS board chiefs in September last year identified a potential £1 billion black hole in the finances of the NHS in Scotland. The minutes of that meeting of NHS bosses stated that they had almost been given the green light to think the unthinkable about the foundations of the NHS in Scotland, with the wealthy potentially paying for their treatment in a two-tier NHS. Is that the kind of discussion that is taking place in NHS Scotland?
Public Audit Committee
Meeting date: 4 May 2023
Craig Hoy
We know, from recently released data, that there has been a 73 per cent increase in the number of Scots electing to go private for some treatments. What would you, as NHS Scotland chief executive, advise me to do if I was 80 and in pain, immobile and suffering from social isolation because I required a hip replacement and I had the means to pay for it?
Public Audit Committee
Meeting date: 4 May 2023
Craig Hoy
That is fine. We have talked about financial sustainability in the NHS, and you have identified reform and innovation as being critical to the long-term sustainability of the NHS in Scotland. Clearly, there was the meeting at which there was blue-sky thinking. At some point, we need to engage the public on what healthcare will look like in Scotland over the next five, 10, 15, 25 and 50 years and the timetable for that. How do you intend to engage with the nation and have that conversation about our national health service?