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Well—

The funding envelopes, by their very nature, are constrained by the availability of funding. Funding growth is very limited. The funding outlook is the funding outlook, and we are not able to change it, so it is a case of what goes where.

I have already referred to the uplift in health and social care over that period. I have been honest about health having benefited above and beyond the resource consequentials that we said we would pass on. The bigger question is what that resource will be spent on. As I said earlier, we are not going to say, “Right, we’re going to change that commitment to uplift the health and social care spend, because we are going to spend it on something else.” It is more about what that spend will deliver over the course of the spending review; it will have to deliver and be spent differently from how it delivers and is spent at the moment. The same could be said for all parts of the public sector, but health is such a big part of the spend.

First, with regard to the inputs, we have delivered above and beyond the resource consequentials to health for as many years as I can remember. That is a fact, but your question is about what is delivered for that. Albeit that there was additional money, over the past eight or nine months, there has been a major improvement in productivity and in the way in which that productivity has been delivered, with extra appointments and procedures and people being seen more quickly. The challenge will be to sustain that improvement, and that is what health boards are being tasked to do, so subnational planning is a key part of that. It is not about putting money in and then it just goes. The productivity has to be sustained and that is about what is done where. We must make sure that we utilise sites to the best of their ability and have more elective surgery sites that are away from the emergency care interruption that we get in some of our major acute hospitals. All of that is subnational planning and looking at the map. It is not about health boards doing their own bit, but about looking at the whole map and doing that subnational planning. That will be absolutely critical to sustaining increased productivity.

It is also worth putting on the record that the Office for National Statistics has said that there are key differences in the way that things are measured, so some of the headline statistics for England, Scotland and Wales are not directly comparable. Nevertheless, your point about productivity is right. It now needs to be sustained, and that is the challenge. The First Minister has been absolutely clear with our health service managers that that is the expectation.

I touched on this in my opening remarks. We have set out that level of detail, given the uncertainties over the spending review period, apart from in the major areas of spend—health, social security and local government. There is probably scope in the future to go further than that, but that level of detail compares well with the departmental levels that are provided in the UK Government budget. We have given a level of detail that the UK Government has not, but the lower the level of detail, the more constrained we are in future choices.

Do you mean the timeframe that the pipeline is operating within?

I get that.

I understand the point that the board is making and I am not unsympathetic to it. The difficulty is that we have to, as best we can, align the infrastructure investment pipeline with the capital availability that we know we have. That constrains how long an outlook we can have. We could set out a pipeline that is based on speculation rather than what we think the capital envelope will be, as that envelope will probably change. We cannot set out projects and have work done on them if they have absolutely no possibility of ever seeing the light of day.

It is a bit of a quandary, because there are benefits in setting out that longer timeframe. However, if you only know the capital availability up to a certain point, what would we be basing that timeframe on? I acknowledge that there will be a tension because of that, for sure.

You just need to look at the way in which things such as serious and organised crime, for one, have been tackled.

Everything follows on from that, including whether the data sets will be available in the new fiscal framework environment. Clearly, if it is a more ambitious and quite radical review and there are more flexibilities and levers, you would want data sets that are in line with that. However, we are in the foothills of that work at the moment.

As for best practice, I absolutely agree. “Once for Scotland” is still very much a mantra in the health service, but it needs to deliver that. There is a bit of what I would call a “Not invented here” view, not just in the health service but in other parts of the public service—you see it in local government, too. It makes you think, “Why?” If something demonstrably works, there will have to be a pretty good reason for not implementing it.

It might be that something that works in a densely populated part of Scotland might not have direct applicability to a very remote or rural part of Scotland. That is understood. As a general rule, however, if something works, it should work everywhere, and we are taking that approach. You would have to have a pretty good reason for not implementing change that demonstrably benefits services, and work is on-going in that respect. We do not always hear about it, but a lot of innovation is indeed happening, and that innovation should be harnessed.

A reflection that I would make, having spoken to those who deliver services directly—not just the managers who manage them—is that they tell you all the time that they can see ways of making changes. Those on the front line need to be listened to.