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I have a question before we leave this area. Auditor General, you have mentioned the KPMG report a couple of times. One of the key messages that the auditor attached to the report is that staffing levels are out of kilter with the number of beds in NHS Grampian. The report goes on to cite different grades. It says, for example, that there has been a 16.4 per cent increase of nursing whole-time-equivalent staff in the past three years, a 17.8 per cent increase of medical and dental WTEs, an 18.2 per cent increase among the administrative staff, and an increase of over 33 per cent when we get to other therapeutic staff. KPMG’s argument is that there are far too many people employed by NHS Grampian and that its cost base is out of line; it says that that is a deficit driver that it would not expect and so on. However, if the narrative is that these are positions that were previously outsourced to agencies at great expense and have now been brought in-house, that might be a good thing. Do you have a view on that?

I am not quite sure that that is what I took from the KPMG report. You have said, and it is in your section 22 report, that NHS Grampian has the lowest bed base per 1,000 population and so on, yet one of the things that is highlighted in the KPMG report is that there has been a further reduction in the number of beds available in NHS Grampian. It also goes on to talk about how artificial intelligence could be brought in to replace some of what it describes as lower grade staff. I am not quite sure whether we would sign up to that, but there are some ideas out there about how things can be streamlined, are there not?.

I guess that there are broader questions here about bed numbers, which is an issue that came up in our discussion about NHS Ayrshire and Arran. Is reducing the number of beds one of the Government’s targets as a means of driving down the cost base in territorial health boards?

Fine—thank you. I will now invite Colin Beattie to put some questions to you.

The traffic-light system at the end of the report, which indicates which services are exceeding the targets and which are falling below them, is a very useful addition. On the face of it, if a health board was overspending its budget and achieving much better outcomes for its population, one could say that there might be some merit in that, but, in the report, you portray a health board that is overspending its budget and relying on bailout loans from the Scottish Government and which, even then, is still not meeting targets on accident and emergency waiting times and so on.

I am conscious of the time, so I will move things along by inviting Colin Beattie to continue to pursue the fctheme of financial sustainability.

I will now invite Graham Simpson to put some questions to you.

Welcome back. We will now turn to agenda item 3, which is consideration of the 2024-25 audit of NHS Grampian, which has warranted the production of a section 22 report. I am pleased to welcome back the Auditor General, Stephen Boyle. I also welcome back Leigh Johnston, who is a senior manager at Audit Scotland. We are joined for this session by Alison Cumming, who is executive director, performance audit and best value, at Audit Scotland.

Before we ask our questions, I invite the Auditor General to make an opening statement.

Thank you very much. Of course, the IJB structure was set by legislation passed by this Parliament, so it is very much of interest to us that you are doing further work in this area to see whether the intention has been carried out in the implementation.

I will invite Joe FitzPatrick to put some questions to you.

Okay. I will finish where we started. As I understand it, this is the first time in 20 years—two decades—that a section 22 report has been presented to Parliament on NHS Grampian. The final question from me is: what has led us to this point? In the report, you start off by talking about the financial position: the £65.2 million brokerage in the financial year that the audit is from, the loans outstanding being £90 million and so on. If it was just the financial position alone, would that warrant a section 22 report, or is it warranted by a combination of the financial position together with those performance issues, the Healthcare Improvement Scotland inspection of Dr Gray’s in Elgin and the traffic-light performance review attached to the report, which shows there are some major areas of concern in delivery of key treatments? Is it around the bed capacity issue? If it was just performance issues, would there be a section 22 report? If it was just financial issues, would there be a section 22 report? Is it because there are both sets of issues that it warrants, in your view, a section 22 report presented to Parliament to outline your concerns?

Okay, thank you. On that key message, we will draw this morning’s evidence session to a close.

Thank you again for the very useful evidence that you have provided for the committee this morning in our consideration of the audit report into NHS Grampian. I thank Alison Cumming, Leigh Johnston and the Auditor General for providing us with lots of food for thought.

I will now, as previously agreed, move the committee into private session. Thank you.