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I do not think that that stops the focus on performance in general, but it might be an obstacle to generating the necessary shift in activity or focus to enable that. There can be a mismatch between the things that we measure and the things that we want to achieve, which are often two different things.

No. I will continue with my Scottish Enterprise example. If I sent a letter of guidance to the chair of Scottish Enterprise and then saw that the organisation was not going in the direction that I wanted, the first conversation would be between the chair and I, in which I would ask what was going on.

The board is accountable for the direction of the organisation and delivery of its purpose. The SMT has to turn that into operational reality. The board is just as responsible for and accountable to direction from ministers as it is for addressing issues that are entirely the statutory right of ministers to set out.

There has to be a balance in all those considerations. There is a necessary place and purpose for accident and emergency services to operate in a highly efficient fashion, because that will deliver the best patient outcomes. The challenge is to ensure that the system works more effectively, so that people are able to get accident and emergency services quickly when they need them. Although we support vibrant and effective A and E services, we also have to have effective social care packages to avoid cases ending up in A and E unnecessarily because no social care package was available for the home.

The lesson is that we need to consider the questions on a whole-system basis. When I was questioned about the Scottish Ambulance Service and answered for the First Minister a few weeks ago, all my answers were about the fact that the challenge is a whole-system challenge. It is not just about the compartment that we call the Ambulance Service. What goes on in a range of other compartments in our public services affects the Ambulance Service compartment. Collaboration and co-operation of the style for which the Christie commission argued are central to resolving some of the more high-profile questions, such as ambulance and A and E waiting times.

Compartmentalised budgeting is undoubtedly a challenge. Another challenge is lining up procurement processes so that all organisations arrive on the same day, because different organisations might have different levels of financial security.

One question is whether there is the necessary perspective and vision to imagine such concepts. I dare say that, when the Midlothian and Tillydrone facilities were being conceived of, there might have been a wee bit of people thinking, “Oh really? Are we sure that we can pull this off?” Vision and commitment are needed to make such examples happen.

There are fundamental conundrums that are difficult to resolve; one person’s local flexibility is another person’s postcode lottery. It is as blunt as that. That relates to the point that the convener put to me. I struggle to get my head around why one would resist change when faced with robust evidence that what is being done could be improved by following the example of what is being done in another locality. If another locality demonstrates that it can get a better outcome by doing something in a particular way, why resist that?

To be fair, I note that many public sector organisations learn a lot in that respect. However, if discernible and evidenced progress is being made somewhere but others are resistant to change, that needs a wee bit of challenge.

I do not really accept the premise of Liz Smith’s question on trust in our public services and the political system. Long-standing, reputable surveys of public opinion and principally the Scottish social attitudes survey—some of the witnesses who gave evidence three weeks ago will be well familiar with it—show strong and high levels of trust in public services and the system of government in Scotland. That trust is at high levels—much higher than in the rest of the United Kingdom.

An important question is how we ensure that there is a clear understanding of the rationale for decision making in the delivery of public services. That takes us into difficult territory. In my years, I have sat through tricky discussions about the delivery of healthcare, for example, when the rationale for making a change in the delivery of a service has been explained from a clinical perspective and makes strong, rational sense but conflicts with how that has been done in the past and how people feel about location-based services. Such discussions are very difficult. The answer to that is to ensure good, clear and engaged processes.

The last point that I will make—I should have said this in response to Liz Smith’s earlier question about the role of professionals—is that any decent public sector organisation should be listening and responding to its front-line professionals. If someone who is running an accident and emergency department says, “Look, it would be better if we organised it this way, rather than that way,” I as a public sector leader would be hard pressed to say, “I think I know better than you do.” All organisations should listen to their front-line people.

It is not a word that I often use about this matter, but I felt it appropriate to use it now. I think that the Christie commission report is highly ethically based—it certainly had a profound impact on me. At the time we commissioned it, a great debate was going on about the proper role of public services. The Christie commission might not have used the word “ethical”, but it provided us with an ethical justification for the maintenance of public services. As I have said, there was a great debate at the time over whether everything should just be privatised, the degree of private involvement and so on.

I thought it appropriate to use the word “ethical” now, because when I look at some of the issues that we have been wrestling with for some time now—for example, fair work, the transition to a green economy and the more sustainable use of resources—I think that they reinforce the ethical purpose of the Christie commission.

I think that that is a legitimate question, although the issue is not just about that. If one is going down the route of exploring these questions, there is an almost philosophical debate that needs to be had about determining the right level for a particular subject. With some of the issues that I still wrestle with around child protection, for example, some very sophisticated knowledge is required. We have to be certain about the approaches to child protection in all localities in the country. Clearly, we do not have a national system of child protection, but we have to be satisfied that the right level of child protection exists in every locality. Local authorities have populations that range from 25,000 to 1 million, and they support different levels of expertise to enable us to be assured that the right level of protection is available in all circumstances.

I hope that, in my answers, I did not create the characterisation that Mr Johnson has put to me. In terms of formal statutory accountability, that may well be the relationship, but, for a range of organisations, there are many other channels of accountability. For example, health ministers undertake annual public scrutiny of individual health boards, which members of the public can watch and engage with. A variety of accountability mechanisms can be put in place in that respect.

Going back to 2007, I recall that we took steps to declutter. We removed a range of public bodies and we passed the Public Services Reform (Scotland) Act 2010, a consequence of which was that further rationalisation work was undertaken. However, over time, different reforms took place that moved in the opposite direction. There is an argument for keeping such questions under review and considering whether further actions are required.

When we undertake structural reform, we must always be aware of the likelihood of disruption to service delivery. I was not a member of Parliament at the time of the local government reorganisation in 1995-96, but I remember that, during that period, it felt as though there was more focus on the reform than on aspects of service delivery. We must be mindful of those questions when undertaking structural reform.