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I am trying to get my head around who is to blame here. NHS Ayrshire and Arran has been on level 3 for eight years, so there is financial intervention every single year. The idea that that is a loan is nonsense; I would put money on the fact that it is never going to pay this stuff back. The model is broken, in my view. Something is clearly going wrong, but I cannot quite work out who is to blame. Is it governance issues? Is it the board? Is it the management team? Is it the Government? Is it ministers? Is it all of the above?

Can we cut to the chase? Are we just dancing around the issue that the current model is not working? The unsustainability that you highlight in your audit is a long-term issue; it is not a one-off. It has been happening for nearly a decade, and it is probably going to continue in the same direction, if not get worse.

The idea is that the Government is somehow helping out by stepping in and plugging financial holes, painting the picture of it saving the board. Do you think that the Government needs to have a fundamental look at the entire model to rephrase it, reframe it and be a bit more honest with the public and the health board about how it is funded and what it expects of the board?

I have one final question. The idea of brokerage is political lingo, but is there a reason why the Government frames it in that way? Essentially, it is saying to boards that, if they are spending more than they have, the Government will make up the difference in the form of a loan. Are there financial or audit reasons why it would do that? Is someone sitting in a civil service room saying, “Minister, do not just give them cash—give them loans”, because it has a financial benefit or some knock-on effect down the line or in the way that the Government reports its accounting?

If we multiply the approach across all boards, it is a substantial sum of cash. Why would ministers not simply say, “Look, if you need £30 million to meet your health objectives, we will give you that”, rather than continue a pretence that the money is a loan? It is never going to be paid back.

It is not really a loan; there is no expectation that it will be paid back.

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 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?

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.