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Official Report: search what was said in Parliament

The Official Report is a written record of public meetings of the Parliament and committees.  

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Dates of parliamentary sessions
  1. Session 1: 12 May 1999 to 31 March 2003
  2. Session 2: 7 May 2003 to 2 April 2007
  3. Session 3: 9 May 2007 to 22 March 2011
  4. Session 4: 11 May 2011 to 23 March 2016
  5. Session 5: 12 May 2016 to 4 May 2021
  6. Current session: 13 May 2021 to 5 November 2025
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Displaying 3443 contributions

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Public Audit Committee

“NHS in Scotland 2022”

Meeting date: 23 March 2023

Richard Leonard

The main agenda item is consideration of the Auditor General for Scotland’s report on the national health service in Scotland in 2022. It was released exactly one month ago today. We are pleased to welcome the Auditor General for Scotland, Stephen Boyle, to give evidence on that report. He is joined by executive director, Antony Clark; senior manager, Leigh Johnston; and senior auditor, Fiona Lees; all from Audit Scotland. You are all very welcome.

We have a large number of questions to put to you on what was an impactful report. Before we ask those questions, the Auditor General will make a short opening statement.

Public Audit Committee

“NHS in Scotland 2022”

Meeting date: 23 March 2023

Richard Leonard

Is the clinical hub a pilot in one particular geographical area? How is that working?

Public Audit Committee

“NHS in Scotland 2022”

Meeting date: 23 March 2023

Richard Leonard

I am quite sure that we will be interested in keeping a close eye on that.

Public Audit Committee

“NHS in Scotland 2022”

Meeting date: 23 March 2023

Richard Leonard

Thank you. We have mentioned the national treatment centres a few times this morning. They are, in part, a national health service response, in place of the private sector, to some of the pressures. Three national treatment centres that were scheduled to open last year did not open. The last I saw, they were scheduled to open in the first half of this year. Rumour has it that the First Minister, in one of her final acts, may open one before the end of the week, but whether that is true remains to be seen.

My serious point is that there have been delays. Can you elaborate on your understanding of the reason why the opening of those treatment centres was delayed? That delay has also contributed to the pressures that we have been talking about for the past hour and 20 minutes, has it not? Can you update us on whether those NTCs are on schedule to open this year?

Public Audit Committee

“NHS in Scotland 2022”

Meeting date: 23 March 2023

Richard Leonard

Presumably, you will also keep an eye on how that fits in with net zero targets and that whole agenda of how the public sector estate needs to be changed quite substantially to meet our ambitious goals for reducing carbon emissions.

Public Audit Committee

“NHS in Scotland 2022”

Meeting date: 23 March 2023

Richard Leonard

That is very helpful. I will develop that theme a little bit. There is the question of innovation. It comes back to the fact that it is not just about the money but about how we do things. You cite in the report a couple of examples of innovation. One of those—the NHS 24 system—is a bit more long-standing and structural. It has been reviewed and reformed.

There is a case study in the report about the Scottish Ambulance Service intervention. I think that you said that it has established an integrated clinical hub to introduce a level of clinical judgment to determine whether, where there are calls for ambulances to attend, a reasonable demand is being placed on the service. The finding that the Scottish Ambulance Service supplied to you was that, when interventions were made, it was discovered that up to 50 per cent of the calls did not require a 999 ambulance. That result is based on intervention in 15 per cent of calls. Will you reflect on that? If there were a greater level of intervention so that more calls were screened or had that clinical judgment applied to them, would that lead to the same kinds of results right across the entire service?

Public Audit Committee

“NHS in Scotland 2022”

Meeting date: 23 March 2023

Richard Leonard

Okay. Obviously, we are talking about people, but, from an audit point of view, the unit cost to the health service of agency staff is considerably more than the cost of a direct employee, is it not?

Public Audit Committee

“NHS in Scotland 2022”

Meeting date: 23 March 2023

Richard Leonard

Thanks. Another area mentioned in your report is NHS 24 interventions. By the same token, how effective have they been? Is NHS 24 revising the way that it works? Is more investment going into it, particularly given the Covid-experienced environment that we are now in? The delivery of public services is viewed slightly differently, is it not, in light of what had to happen over the course of the pandemic? Can you enlighten us on the NHS 24 changes or interventions and how effective they have been?

Public Audit Committee

“NHS in Scotland 2022”

Meeting date: 23 March 2023

Richard Leonard

That is fine. We will, I am sure, return to those issues in subsequent sessions on the NHS.

Public Audit Committee

“NHS in Scotland 2022”

Meeting date: 23 March 2023

Richard Leonard

The NHS is a very high priority for all of us in the Parliament and I reflect that the terms of our debate about it often contrast inputs and outcomes. Your report notes that there has been a £4.4 billion increase in NHS spending since 2018-19 and that the budget for 2023-24 is estimated to be over £19 billion. You assessed that level of expenditure as being three years earlier than anticipated. There is no question that there is substantial public investment going into the NHS, yet we do not necessarily see outcomes improving. The rather fundamental question is, do we just need funding or is it necessary to apply other factors in order to rise to the challenges that we are facing in the national health service?