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The target for A and E treatment is that 95 per cent of people are dealt with within four hours. That can mean that someone is admitted to hospital, if that is considered necessary, then discharged, or treated then discharged. The current average performance is 69 per cent, which exactly marries up with what you have just said—far too many people in A and E are not being treated, moved on or moved out of that environment, which has a knock-on effect on ambulances.

What is the issue in A and E specifically? Are people turning up when they should not? Is it understaffed? What is the problem? What is causing the delay?

The figures are atrocious. I point you to page 48 of the Audit Scotland report, which I flagged at a previous meeting of the Public Audit Committee. What you would normally expect to see on that page—as I am pleased to see in other tables—are little green ticks where targets have been met. However, there is not a single green tick anywhere on that page.

The numbers speak for themselves. The targets are 95 per cent, 100 per cent and 90 per cent for beginning treatment within given timescales. They are ambitious. I get that. I know that the health service is very challenging across the UK, but look at the performance measures on that page. Look at in-patient treatment within 12 weeks of a decision to treat. The poor people in Grampian are sitting at 46 per cent of the 100 per cent target. Fife and Forth Valley are at 47 per cent. For the three targets, Lanarkshire is at 61 per cent, 46 per cent and 60 per cent—nowhere near the targets. There are huge numbers of people waiting for far longer than they should, and £100 million is not going to scratch the surface, is it?

It has already been mentioned, but one of the issues at the other end is delayed discharge. We have talked a lot about the flow of people going into hospital, but getting them out is key. However, I am afraid that the statistics on that are equally atrocious. In 2023, 658,000 bed days were taken up by delayed discharge. Those are days on which beds could have been occupied by all those people who were sitting in A and E waiting to be admitted. We do not have the full statistics yet for 2024, but doing a year-on-year analysis from November to November, there was a 7 per cent increase in delayed discharge days. My fear is that the number for 2024 will not be great, either.

Of course, the Government promised to eliminate delayed discharge completely, but I do not know how on earth it thought that it was going to do that. It was an admirable ambition, but it is clearly not happening. We had a conversation earlier in which you admitted to being the accountable officer for NHS health and social care, but many of the levers that are required to deal with delayed discharge are entirely outside your control. It must be a huge source of frustration that you cannot really fix that problem, can you?

That is a whole other committee session, is it not?

I will try to squeeze it all into one. I pre-empt it by saying that, if you do not have the responses to my question, you are welcome to write to me or the committee with the statistics that I am looking for.

First, how many people in the Scottish Government work for the constitutional futures division, and what is the annual cost of that department within the civil service?

Secondly, can you confirm today that all members of staff working within the Scottish Government pay income tax in Scotland? If the answer is that some do not, how many of them are there, and into which pay bands do they fall?

Understood. Thank you.

Good morning, permanent secretary and witnesses.

To start, I would like to look at the macroeconomic state of affairs that is reflected by the consolidated accounts. The consolidated accounts give us a better understanding of the state of the Scottish Government’s finances and its three main sources of income. Obviously, the block grant is outside the Scottish Government’s control, but the other two sources—that is, borrowing and devolved taxation—are within the control of ministers.

Will you give an overview of whether you are content that the decisions being made in the two areas that are under the Scottish Government’s control are being taken in such a way as to maximise the potential income that is available to ministers and therefore translates into their budget spending decisions?

Thank you for that comprehensive answer. There is quite a lot in there, so I will pick out some of the areas that you have just mentioned.

You talked a little bit about spending decisions as a result of further devolution. This committee, other parliamentary committees and Audit Scotland have noted that, with that further devolution, those decisions have a further financial cost to the Government. As we have seen in the analysis of budgets, they are also often made at the expense of other portfolios. For example, the social security spend is rapidly increasing to the point at which it might reach par with the health and social care budget, which is a new phenomenon. However, it is entirely unclear whether the variance in devolved taxation levels in Scotland compared with other parts of the UK is adequately funding the spending policy decisions that ministers are making. Are we therefore looking down the barrel of the supposed black hole that people talk about where spending decisions are uncontrollable and unfundable? Where does the money come from if not from the block grant? Does it come from higher borrowing or higher taxation?

I guess that we are looking for some comfort that those decisions are being looked at in the round.

What I cannot get my head around is that there is still headroom, which means that ministers have had—and still have—the ability to borrow more if they wish to. In the financial year 2023-24, for example, the Scottish Government borrowed £300 million to support capital projects, which was less than the £450 million that was initially outlined in the budget, so there was significant underborrowing, so to speak. At the same time, there was a mid-year review into capital investment that led to a number of projects not proceeding.

The public will look at that and say, “You have had headroom to borrow cash, yet at the same time there is a freeze on capital investment in much-needed projects—for example, in the national health service or in other infrastructure projects”. The public will not understand why such projects are not going ahead when, at the same time, ministers are not borrowing the cash that is available to them. How do you marry those two things together?

Given the huge pressures that public finance is under—we have spent two hours talking about them—are you comfortable about the fact that there are civil servants working for you on theoretical white papers—13, I believe, in total? Does that sound like good use of civil service time and taxpayers’ money to you?