Seòmar agus comataidhean

There are a lot of questions to ask, and I will probably come back in later. I want to have a conversation about preventative health care and some of the reforms that you have talked about, which may improve outcomes down the line as opposed to just costing more money.

I draw attention to exhibit 5 of the report, which I found quite interesting. When digging below the surface to work out why health boards are running out of money and why so many of them face deficits and are borrowing money, I read about “prescribed drug costs” and “staff costs”, which goes back to my first question about pay increases and what is driving them. Has Audit Scotland done a piece of analysis on the main drivers of the current situation? Is it simply due to pay awards and the increased cost of drugs from pharmaceutical companies, or is there something else that we are missing?

James Dornan raised some important issues there. I want to carry on with that theme, and particularly A and E. As has just been mentioned by one of your colleagues, Auditor General, we are sitting at around 70 per cent of the target of being admitted, discharged or transferred for treatment within four hours. However, we know that there is a huge disparity across the country in how quickly someone will be seen, depending on where they live and the hospital that they are taken to. In NHS Forth Valley and NHS Lanarkshire, that figure is as low as 54 or 55 per cent of target, which is shockingly low. However, NHS Tayside and NHS Western Isles are at 90 per cent and 96 per cent respectively.

I can speak only from my own experiences. In my health board, my local hospital is Inverclyde royal hospital, and the figures there are quite stark. There has been an 8,000 per cent increase in people waiting in A and E for more than four hours and a huge increase in those waiting for more than 12 hours. Is there any understanding of why there are such huge health board disparities in NHS A and E waiting times?

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.