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What impact will that have on treatments? I chair the cross-party group on life sciences, and we had a presentation from the chief executive of Moderna, who came all the way from Texas for the meeting. He was talking about messenger RNA being used for individual cancer patients so that a cure is developed based on someone’s specific DNA, as opposed to anyone else’s. It costs an absolute fortune—although he did not put a price on it, of course, because it is still at the development stage. However, it looks very promising, particularly for people who have cancer that is at a very advanced stage.

We also have things such as Ozempic, which could have a cost benefit. It might cost £1,500 a year, but if it prevents heart attacks and strokes, it could potentially save a lot of money in the long run. How do we balance those types of developments through a cost benefit analysis? As another example, a new cure for sickle-cell anaemia has been developed out in Roslin—apparently it costs £1.6 million per patient.

Some treatments will be very cost beneficial, and there are also quality-of-life issues; we are talking about individual human beings. Nevertheless, from an economic point of view, when you are forecasting in an area that is as complex as health, how do you balance the costs and benefits of those different innovations?

One of our concerns, when we see that potentially up to 55 per cent of the Scottish budget will be spent on health by 2075, all else being equal, is the fall in productivity in healthcare.

As you say in the report, productivity in manufacturing, for example, through technological innovation and so on, is a lot easier to increase than productivity in areas that are labour intensive, such as healthcare. We have seen a quite substantial reduction in the productivity of the health service across the UK since the pandemic. What impact has that had on your projections, and do you expect that reversal to be turned around over the next five or 10 years?

Despite that, there seems to be less focus on that issue than there has been in recent years.

Are there any further issues that we have not covered that you want to emphasise?

I have another couple of questions.

Last week, Professor David Bell said that further improvements can be made, including to provide clarity around regular in-year transfers in the Scottish budget. When we look at the spring and autumn revisions, my colleagues and I often raise the issue that, every year, we get the same transfer of resources from one budget line to another. We have speculated about the reason for that, but what is your view?

Natalist policies have increased the birth rate in Denmark, but not to replacement level. The only developed countries with birth rates above replacement level are the Faroes and Israel, as far as I am aware. Incidentally, Hungary has said that any woman who has two children before the age of 30 will not have to pay tax for the rest of her life. Who knows whether that will have an impact?

Good morning, and welcome to the 14th meeting in 2025 of the Finance and Public Administration Committee. We have received apologies from Michael Marra, who will not be attending the committee this morning. Ross Greer will participate, but he will not arrive before 10:15, so unfortunately he might not participate in this item.

The first item on our agenda is an evidence session on the Scottish budget process in practice. We are joined this morning by Stephen Boyle, Auditor General for Scotland, and Fiona Diggle, audit manager at Audit Scotland. I welcome you both to the meeting and I invite the Auditor General to make a brief opening statement.

I think that everybody wants the populace to be more engaged. We would like, on occasion, the people who gather in the public gallery at meetings of this committee to be more than just the people who will be giving evidence next or a couple of students who wander in and, five minutes later, decide to wander out again. We would all like more engagement, but it is about being realistic, practical and pragmatic.

The first group of people who need to be au fait with all the documents are probably elected representatives in this Parliament, in the UK Parliament and in local authorities, as well as the people in the third sector who deal with these issues. Sometimes, it can be quite unrealistic to talk about public buy-in, because people have priorities other than to look through a 140-page draft budget document and a 90-page sustainability document. Life really is too short for most people to do that.

In what way? How can you make the budget document more accessible?

It is just an empty statement, is it not? It means nothing unless the recommendations say what the languages are, how many there should be and what the cost implications would be. I find it frustrating when I read things like that, to be honest. It is almost a throwaway line rather than a serious policy intent.

Are they relatively small steps? It may be that only half a dozen people would read the document in those languages, and it would cost a huge amount—probably thousands of pounds—to translate it into one other language, never mind more. Do we know many languages are being proposed?