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I mention that because your report highlights that, in June 2019, 250 Scots were waiting for more than two years for in-patient treatment, and the figure has jumped to 7,100. Even just a small percentage of those people who are waiting and waiting for treatment might not make it—that is a piece of statistical analysis that one can do. As a percentage of 250, the figure would, I hope, be relatively low but, as the number waiting nears 10,000, you are talking about hundreds if not thousands of people not making it.

I guess that the point that I am raising is whether we should look at that. Could a piece of work be done on needless mortality in Scotland as a result of horrendously long waiting lists?

How many people have died while on an NHS waiting list?

I was not expecting to come in so early. Good morning to our guests.

I want to look at the bigger picture, so let us take a top-level approach to this. In your opening statement, Auditor General, you painted quite a stark picture of Scotland’s NHS. Despite a 2.5 per cent real-terms increase in funding from central Government, outcomes and outputs seem to be poorer and, in many areas, getting worse. Fewer patients are being seen, waiting times are getting worse, there are further delayed discharges from hospitals and, of course, there are the A and E waiting times—all of which we will come to in this session.

I suppose the logical question is: how on earth can the Government be spending more and more money on a public service but things be getting worse? In your opinion, what are the main drivers of that?

Do we have too many NHS boards in Scotland?

Are you surprised—or, indeed, disappointed—that we do not have medium-term financial strategies from our Government? It seems to me that producing this kind of high-level strategy is a really basic aspect of the governance of public finances, but year after year, we hear these criticisms that it does not exist.

Just to throw a spanner in the works, some of the early analysis of yesterday’s announcement paints a bigger picture around how we get our heads around the transparency issue when ministers make announcements about new money. I was particularly struck by the summary from the Institute for Fiscal Studies. I am not sure whether you have read that yet, but it left me with more questions than answers. To summarise it briefly for the benefit of others, it paints a picture of announcements that are made on paper—by the way, this is backed up by the SPICe graphics that came out this morning—suggesting around a 5 per cent cash-terms increase or 2.9 per cent after inflation, so a real-terms increase. However, and this is key, it excludes £1.3 billion of funding that the budget documentation implies the Scottish Government still has to allocate to services this year. If that was to be taken into account, you are looking at a flat-cash settlement next year.

Where do I start with this? There is either a 5 per cent cash increase or there is not. I am of the understanding that the Government is unable to roll over money year on year, so how can unallocated money from this year be spent in next year’s budget, for example? Again, that all just raises questions about the veracity of some of the top-line figures that people are seeing in the newspapers this morning, which is why I think that it is important to dig under those figures. Do you have any view on that?

You talked a little bit about the budgets for the NHS, social care and social security. We all know the direction of travel for those budgets—they are becoming an ever-increasing chunk of expenditure for the Government. Presumably, any announcement—whatever the numbers are or whether they are increases of 1, 3 or 5 per cent—will either cannibalise the wider Scottish budget and the total pie available, or is reliant on some additional cash, the value of which is unknown, although we know roughly the value of the spending commitments. You talk about balancing the books. That may be the case, but big spending announcements are being made where there is no clear, backed-up and identifiable source for how those will be funded. Are we able to follow the money, or is there still a lack of transparency and clarity?

Thank you.

That is the point, though. You talked about the two areas where you can get additional money. The first is via the block grant, which presumably is either money that has been pre-promised from the UK Government through top-up funding from the UK budget or Barnett consequentials due to decisions that have been made in Westminster, or block grant asks of the UK Government, which are not guaranteed to be met—the two are very different. Alongside that sit revenue projections from tax intake under devolved taxation. What happens if neither of those increases or if there is no likelihood of them increasing? For example, early projections show that the tax increases announced in yesterday’s statement are less than £100 million, so it is nominal and nowhere near enough to scratch the surface of the spending commitments—the cash spend commitments. Surely the only other option would be for portfolio increases that happen in one area to require cuts in other areas. In other words, to balance the books, the money is just shuffled around from one set of portfolios to another. Either you have new money or you are just shuffling around existing money. It is very hard to determine which it is, and I guess that that is what I am struggling with.

You said in your last answer that the report highlights that social security spending will be £1.5 billion more due to devolved spending decisions, which again are policy decisions for policy makers. I understand that, and I am not asking for comment on the policy itself, but the facts are that they are spending more than they are getting in that portfolio. Presumably, that is unsustainable—the money must come from somewhere.