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Let me rephrase my question: who is not spending their money wisely? Which bit of the system is not as productive as it could be?

I have had a chance to read the other letter from the minister to the Finance and Public Administration Committee, which was, literally, thrust under our noses at the beginning of the meeting. It is quite short, and I was quite struck by the tone. It seems very different from and perhaps less contrite than the other letter. The first two pages are essentially a veritable “Why? This isn’t my fault. It’s not the Scottish Government’s fault. This is the UK Government’s fault.” I have no interest in the politics of all of this, but the minister makes some points that I thought you might reflect on, Auditor General.

On the first page, the minister says that the whole issue extends from the fact that the UK Government

“did not understand the complexity of the remedy”

and had set an unrealistic timeframe.

Three specific accusations are made. First, the UK Government should not have made the changes in the first place, because they were not compliant with the European convention on human rights. Secondly, not enough work was done to identify what timeframes would be needed for the remedy, so the deadlines were completely unrealistic. Thirdly, the UK Government was supposed to issue guidance to various public agencies, but the guidance arrived after the deadlines had passed. Those are quite profound criticisms of the UK Government by another Government. Do you have any thoughts or reflections on that?

The agency alludes to automation in its response, and it seems to have made quite a lot of progress in that regard. We can ask these questions when its representatives come before us, of course, but there is one phrase that the agency used that I quite liked: it stated that it wants

“to get it right first time”.

It will have to spend a bit of time on the calculators and on working out how to remedy. Once that is done, however, the automation of the process can allow the agency to rattle through the case backlog. I assume that that is what it is saying to us, reading between the lines. Is that not a good thing? Would you not want to spend a bit more time setting up those processes—presumably with some manual oversight and intervention—before then reaching the point at which you were comfortable that accurate figures were coming out the other end of the machine? I am sure that the last thing that the agency wants—given the context of Mr Beattie’s line of questioning—is to get through the process quickly and produce wrong information, so that people get statements that are over, under or wildly different. It is hard to criticise the agency for its approach.

They are hot off the press, I should add.

During the most recent session that we had with the Auditor General, we talked about dealing with this long-term stubborn issue, which Mr Beattie picked up on earlier. In the week or so since that session, I have tried to do some analysis of Audit Scotland’s previous reports. The 2005 report was called “Moving on? An overview of delayed discharges in Scotland” and there was a report in 2016 called “Changing models of health and social care”.

There have been repeated Audit Scotland reports over the years. One of things that has never really been clear from all those reports is what lessons were learned. I feel like I have a bit of déjà vu. If I could go back to the audit committee of 10 years ago, I would probably find that it was having the same conversation and getting similar answers from the director general for health at the time. I feel as though we are going round in circles. There is a lot of jargon and rhetoric, but the statistics prove that virtually no progress has been made since those reports came out. My biggest fear is that, during the next parliamentary session, we will be having exactly the same conversation in two, three, four or five years’ time. Fill me with some confidence that the next public audit committee and whoever sits on it will not need to have this conversation again.

That is helpful.

On the issue of adults with incapacity, are those people who are medically fit to leave hospital, but do not have the capacity to look after themselves once discharged? If they were sent home, they would not be able to look after themselves, therefore they are safer in hospital.

That is one area in which there could be improvement.

We have talked a bit about data. Mr Simpson talked about the £440 million mentioned in the report. That was just one year. I presume that that was a primitive calculation based on the number of bed days and the cost per day per bed, which I think is around £618. It is a very simple way of looking at it. There must be a better way of measuring the cost. Do you have a number?

I am not suggesting that you do not staff those beds. My point is that the beds are being occupied by people who do not need to be in them.

Is there any analysis of how many clinical or non-clinical hours are taken up with looking after those patients? After all, once someone has gone out the hospital door, they are someone else’s problem—the duty of care lies with someone else—and that member of clinical staff will be automatically and immediately freed up to look after someone else either in that bed or otherwise. Has that piece of work, or analysis, ever been done?

You are director general for health and social care, so I appreciate that you are not in charge of local government or its budget. However, I presume that you have some influence over the working of integration joint boards, the role that they play in delivering social care and how that links into the wider health and social care budget, which is essentially a unified budget. What would you like to happen? I appreciate that it is difficult to give an analysis when you are the person in charge, but you must know why people are stuck in hospital. You must know the main reasons why you cannot get people out of hospital beds and into another setting. There must be analysis of the main reasons for that. You will know what the sticking points are. What are they, and how will you go about fixing them?

Forgive me, but that sounds a bit like you are saying that it is not getting any worse but it is not getting any better, so that is fine. I am not talking about a blip. The report is not about one year out of the ordinary but a pattern that has been repeated over the decades since a promise was made to eradicate delayed discharge. I question whether it is possible to eradicate delayed discharge at all. It has been sitting at around 3 per cent of all discharges and consistently affecting around 18,000 people, year on year, for the past 10 years. Is that just the base level that we have to accept now?