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Official Report: search what was said in Parliament

The Official Report is a written record of public meetings of the Parliament and committees.  

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Dates of parliamentary sessions
  1. Session 1: 12 May 1999 to 31 March 2003
  2. Session 2: 7 May 2003 to 2 April 2007
  3. Session 3: 9 May 2007 to 22 March 2011
  4. Session 4: 11 May 2011 to 23 March 2016
  5. Session 5: 12 May 2016 to 4 May 2021
  6. Current session: 13 May 2021 to 9 March 2026
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Displaying 2092 contributions

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Public Audit Committee [Draft]

“NHS in Scotland 2025: Finance and performance”

Meeting date: 4 March 2026

Jamie Greene

That brings me to the key point. What obligations are put on the health board so that it can get the money? You agree the figure at the beginning of the year, but what does it have to do to qualify for the cash?

Public Audit Committee [Draft]

“NHS in Scotland 2025: Finance and performance”

Meeting date: 4 March 2026

Jamie Greene

Okay. That is helpful to know.

Is there a wider issue with the funding model? We also heard from NHS Ayrshire and Arran how health boards get allocated their percentage of the pot. I accept that it is a big pot of cash, and that record levels of funding are going into health and social care, but, despite the record funding, waiting lists are still long, as other members will explore, and there are all the other operational issues that we all know about in the health service. Are we comfortable that the current model—the NRAC funding formula—works, and that it is proportionate and fair to health boards such as NHS Ayrshire and Arran, where higher levels of deprivation, an ageing demographic and a reducing population will negatively affect the NRAC funding that it gets?

Public Audit Committee [Draft]

“NHS in Scotland 2025: Finance and performance”

Meeting date: 4 March 2026

Jamie Greene

I want to take us back to the bigger picture and to the premise of the Audit Scotland report. I draw your attention to page 3 of the report, which sets out the key messages that sum up where we are at. These are not trick questions; I genuinely want to try to get underneath the skin of some of this.

In key message 1, the sentence that jumps out at me the most is the second one, which says:

“Even with increased funding, the NHS in Scotland is not in a financially sustainable position.”

Surely that must be a point of concern, given that you said that you accept the content of the report and its recommendations. Caroline Lamb, why, in your view, is the NHS not in a financially sustainable position?

Public Audit Committee [Draft]

“NHS in Scotland 2025: Finance and performance”

Meeting date: 4 March 2026

Jamie Greene

Thank you. I appreciate that comprehensive answer. I am glad that you mentioned some of the improvement plans that you have in place. There is the operational improvement plan, the health and social care service renewal framework and the population health framework—there is lots of jargony stuff there.

I am glad that you pre-empted my next question. In point 3 of its key messages, Audit Scotland identified that the ambitions are “long-standing” and many have “yet to be delivered”. However, the key point is the

“persistent implementation gap … between policy ambitions and delivery on the ground”.

That seems to be the sticking point. You can have all the frameworks and plans in the world—and do so with great ambition, which we share—but, as Audit Scotland has identified in its key messages, if the delivery on the ground does not match that ambition there will be a problem.

Public Audit Committee [Draft]

“NHS in Scotland 2025: Finance and performance”

Meeting date: 4 March 2026

Jamie Greene

Yes—I would like to interrogate some of the operational areas where you are making changes. Some of them are quite visible in the health service and people are already seeing new ways of being treated or dealt with. However, before I do that, I want to cover some of the financial issues, because that is an important area. We have taken quite a lot of evidence on it, and we have heard from two boards that are in a perilous financial position.

The issue of brokerage has come up quite a lot in our sessions, and the Auditor General spoke at great length about it when he gave evidence. There is cumulative brokerage—and when we talk about brokerage, we are talking about loans to health boards from Government—of £0.5 billion. That is a lot of money. If that money was ever to be repaid, surely it could be reinvested in the health service. However, let us be honest. Do you expect any of the money ever to be repaid? Which health board is in a financial position to pay back the loans?

Public Audit Committee [Draft]

“NHS in Scotland 2025: Finance and performance”

Meeting date: 4 March 2026

Jamie Greene

The new model is not a loan—it is just a cash intervention. How is that different? Is it more limited, or more limiting?

Public Audit Committee [Draft]

“NHS in Scotland 2025: Finance and performance”

Meeting date: 4 March 2026

Jamie Greene

The problem with agreeing the funding at the beginning of the year is that it still leaves health boards short. For example, NHS Ayrshire and Arran made it clear in evidence to us the other week that what it expected to get in deficit support funding was still less than its deficit.

Public Audit Committee [Draft]

“NHS in Scotland 2025: Finance and performance”

Meeting date: 4 March 2026

Jamie Greene

The problem with that is—

Public Audit Committee [Draft]

“NHS in Scotland 2025: Finance and performance”

Meeting date: 4 March 2026

Jamie Greene

It is, but it is also a chicken-and-egg situation. If half of your budget is spent on treating people who are unhealthy, there is less money to spend on, for example, the preventative work to make people’s homes safe and warm, on education, and on treating drug and alcohol problems, mental ill-health and homelessness. There will be less money to go round every other portfolio when half of all Government cash goes to yours.

Public Audit Committee [Draft]

“NHS in Scotland 2025: Finance and performance”

Meeting date: 4 March 2026

Jamie Greene

Okay—I will leave it there.