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We should be open to doing more of that, to be honest. In the light of the experience of the operation of organisations such as SNIB, having more flexibility, within reason, is not an unreasonable ask.

We expect cabinet secretaries to be in constant contact with public services on areas that are most likely to experience the biggest impact. For example, there will be an impact on fuel costs. Cabinet secretaries will discuss with various public bodies and delivery bodies what the impact will be in reality and what that will mean for budgets and when things can be delivered.

Your question raises a wider issue about the lack of flexibility in the fiscal framework. I know that you have raised it before, as have I, and I will continue to do so. It will be really important for the next parliamentary session. Things like this come along and the levers that we have to flex in order to deal with an impact that could last for a number of years are extremely limited. I have got my last finance interministerial standing committee later this month, and I will continue to press the issue. We have agreed to carry out a review, but its terms must be realistic, given the current climate of uncertainty. The main certainty is the uncertainty of the next few years and what may come at Governments, including the cost and management of the services issues that you are alluding to. That really makes the case for greater flexibility.

: As I said in my opening remarks, it is important to have flexibility to respond to volatility. We can already see where that volatility may come from, with the uncertainty on the global stage, and, within a week of the budget being passed, we had a spring statement with a complete change in the funding outlook—I am sure that we will touch on that a bit more. Although additional funding is welcome, having that just a week after the budget has been passed shows how things move and change straight away. There is then the opportunity to deploy £900 million as part of the spending review.

As I have said before, the budget and the spending review are true at the time of publication, but, because our funding is dependent on UK Government decisions, it can change straight away—and it has.

It does.

Let me say a few things. First, a value-for-money case has to be made.

Indeed. It depends on the social value of a project. For example, projects that may deliver more in the primary care space would have a higher social value when it comes to scoring for the value-for-money case. It is also worth saying that we will never get an equivalent to the Public Works Loan Board. However, when it comes down to doing something or not doing it, the question is whether we find other ways of raising the finance to take, for example, primary care facilities forward. The Treasury is looking at exactly that because of the lack of health capital down south. It is also important to say that, compared with the initial old-school PFI projects, a model such as the mutual investment model is a huge improvement. The Welsh Government has utilised it for a number of projects and has managed to extract a lot of social value and gain out of those projects.

Such projects are a lot better than the PFI projects of the past, but it is still a more expensive way to borrow. If you look at the importance of the primary care facilities—the hubs—in delivering a new model for health, it is hard to see how you could do that without that primary care investment. Unless there is a change of direction in the decline in the availability of health capital, the question will be whether we can do it through only that mechanism. That is a decision that will need to be made by a future Scottish Government.

It is also important to say that we are trying to get intelligence from the Treasury around the models that it might use, because there might be economies of scale when it comes to extracting best value in that regard.

The two priority areas for that are primary care and further education. We have previously used revenue finance models for colleges, so it is not a new thing. Those two areas of priority would currently struggle to get through the capital departmental expenditure limit outlook that exists.

I share your concern about such figures.

First, I would say that the health boards have a good track record of delivering on efficiency savings. We have passed on all consequentials in full and it is fair to say that most commentators recognise that, within the constraints that we are under, health and social care has had a real-terms uplift of 5.1 per cent across the spending review period. However, health board efficiency and reform plans will have to deliver a minimum of 3 per cent per annum efficiency savings, and they will get to keep those efficiency savings to reinvest. That is important, because it is an incentive to generate the efficiency savings.

I should say that this is not unique to the NHS in Scotland. We are seeing similar challenges in efficiency savings in health services elsewhere in these islands. I think that NHS England is required to make efficiency savings of 4.5 per cent. To be blunt, we need to see a transformation of service delivery and it must be driven by efficiency savings.

The structure of health board delivery is a matter for the next Government, but without doubt there will be changes in the delivery landscape. Then there is the question of the shift in the balance of care. It is absolutely fundamental to the population health framework that more is done in primary care. The efficiencies in the system will have to drive that change, too.

I am not saying that it is easy. Health boards will be challenged and how they deliver will be monitored. They will also have to prioritise funding to the front line, which means that they need to look at some of their back-office functions. We have back-office functions in every one of our 22 health boards, whether it is the territorial boards or the special boards, and that needs to change.

Not at all. The Scottish Government gives a lot of support to boards in their delivery. There are weekly meetings on the reduction of waiting lists and improvement in performance, as you can imagine. We also have financial oversight, rigour, challenge and support for every one of the health boards, but change will have to happen. A lot of work is going on around subnational planning in relation to what can be done where, particularly for planned care. We need to make sure that planned care is being delivered in the right places for those procedures that people might have once or twice in their lifetime. That work is all part of the requirement for boards to ensure that every single pound is spent in the most effective and efficient way.

The Cabinet Secretary for Health and Social Care has been clear that there needs to be a shift in resources and output from acute to primary care, so that people can get more of their health services more locally. It is about making sure that procedures that can be done in a primary health setting, in a hub, can be done there, rather than someone having to travel to an acute service.

We are already seeing a lot of that; we are not starting from first base. If you think about eye care, for example, a lot of ophthalmology services are now being delivered in the community, rather than people travelling to hospital. A lot of that is done in partnership with specialists within the acute sector. This will be an evolution because of the size and scale of what we are trying to achieve.