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I will bring in Richard McCallum to talk about our work with boards on how we can share learning.

We have a formal process for monitoring all our boards’ performance, not just in terms of key targets but around financial management. We also conduct an annual review process for each of our boards to evaluate the progress that they are making; they have an in-year review as well.

One challenge that has been around for a long time—I recall this from when I was previously a junior health minister—is trying to make sure that, where there is good practice in one part of the country, it is replicated in other parts of the country. That challenge is not peculiar to health; it is a challenge within the public sector overall. It is always a source of frustration to me that, in a country of 5 million people, we struggle at times to make sure that good practice is replicated and that where it is established, it sticks.

We have a number of different mechanisms through which we seek to do that. One is that we regularly bring our board chief executives together to focus on particular areas of challenge and, where they have taken new approaches, to share that practice. We do the exact same thing with the NHS chairs of the boards. I meet them every six weeks or so; we have the opportunity to focus on key areas where there is good practice or on areas where there are challenges, in order to try to encourage good practice.

We are also making much greater use of the centre for sustainable delivery, which is based at the Golden Jubilee National Hospital special NHS board. The centre was established to look at key areas where there are opportunities for efficiencies and improvement in service delivery. It takes that forward with individual boards and it can model what the impact would be on an individual board if it were to deliver something differently. It can also do specific work with individual boards.

Over the next couple of years, the centre will probably be the key mechanism that we will use to try to get greater consistency, to make sure that we are getting better adoption of good practice where it has been identified, and to bring new ideas to boards.

I will ask Richard McCallum to say more about what we do on finance with the boards.

We are taking forward a range of work to encourage the adoption of good practice where it has been established in one board.

NHS Grampian is taking the project forward. Through NHS Scotland assure, we will provide the health board with as much support and assistance as we can to ensure that it gets these things right and addresses any changes that have to be made. However, I am afraid that there is no additional headroom in the capital budget, given the cut to that budget by the UK Government. That has a direct impact not only on capital projects relating to health, but on capital projects right across the Scottish Government, so any additional costs will have to be met within the overall project budgets.

I am not sure whether we have enough flexibility. That brings me back to the point that Carol Mochan made about the challenge that we face in giving organisations budgets to take programmes forward over the year that then have to be adapted and changed in year when we get information about something coming on to the market. I will have to think about what more we can do to allow some flexibility in that respect.

With regard to vaping, the sector has grown to quite a marked degree—indeed, it has grown exponentially—over the past number of years. It is associated not only with health issues but with environmental consequences, and there is a need for stricter regulation around it. In fact, we are taking forward the joint consultation with the other nations to look at what further restrictions should be put in place. There is no doubt in my mind about the need for proactive action on the part of Government in the preventative space.

I will take away your point about in-year flexibility, but I am conscious of some of the challenges that we face with regard to the way in which we fund organisations if we are looking for them to adapt in the course of a financial year.

I do not know whether it will make that easier, but it will give us the ability to be much clearer about the outcomes that we are looking to achieve with that investment and the public expenditure that goes into social care, and it will give us the ability to seek to achieve much more consistency.

It has benefits for staff, such as allowing for collective bargaining, which I know is an important issue for trade unions. The creation of a national care service will be critical to supporting us to achieve a more attractive place for folk to work, greater consistency in how services are delivered, and better alignment with the needs of our NHS. It will also help us to get greater consistency in how funding is used and ensure that it is being used to achieve better outcomes for individuals who need to make use of those services, in a way that we do not have at the present moment.

There were no significant works and there was no major disruption to services. In the few areas where work was needed, it was done as part of normal routine maintenance work.

The capital budget for the Baird hospital and ANCHOR centre projects is what was originally agreed. Within the overall project—

Yes, I think so. There is always an ambition to invest much more in preventative healthcare where we can. That is challenging when we are in a very difficult financial environment and given the significant demand that services are facing. Notwithstanding that, however, we should do that where we have the opportunity. We have committed to exploring issues around a public health levy over the next year and I think that, if its introduction is agreed to, it would provide an opportunity for investment in other areas of preventative spend.

We should also recognise that innovation in technology can play an important part in some of the preventative approaches that we pursue. I mentioned the work on diabetes. New digital technology could have a real impact in reducing the side effects that people can experience as a result of diabetes and in helping them to live more healthily. We know that that will have a preventative effect in the future because of the benefits that come from it. We know that the use of AI in radiography can help to identify issues at an earlier stage and allow for earlier intervention, which could further reduce expenditure in the future.

Technology and innovation can play a really important part in ensuring that we do more in the preventative space, and any additional investment that might come through a public health levy in future years to support that would be very welcome.

You are right that mental health services are about 8.8 per cent of our expenditure at present and I hope that we will have those services at 10 per cent by the end of this parliamentary session. That will depend on future budgets and the availability of finance, but it would certainly be our intention to do that. As I said earlier, however, there has been a very significant uplift in mental health expenditure since 2020-21. The level of Scottish Government investment in the area has more than doubled, but 10 per cent is still our ambition. We are at 8.8 per cent and we need to look at whether budgets in future years will allow us to continue the increase to achieve a 10 per cent allocation.

It is an operational issue, so I would expect it to be dealt with by boards. They have a whole executive team, so if there was an issue around safe staffing in a particular ward, I would expect that to be escalated through the board’s local management structure—eventually, I presume, to the director of nursing and, if necessary, to the chief executive.

If a wider systemic problem was being experienced and it was brought to our attention, we would certainly want to raise that with the board. In terms of day-to-day operations, it would be the responsibility of the individual board to deal with the matter. However, if there was a wider systemic issue, I would certainly be concerned about that and I would want to take action if there was a problem in a board.

Eventually, it will be a self-funding model, but the proposed arrangement will operate for the initial couple of years, in order to get the regulatory process up and running. As the workforce expands, it will be a self-funding model, which is the way in which most of the regulators now operate. The proposed arrangement is part of the initial process to support the GMC in taking on the regulatory role.