Seòmar agus comataidhean

There are a lot of questions to ask, and I will probably come back in later. I want to have a conversation about preventative health care and some of the reforms that you have talked about, which may improve outcomes down the line as opposed to just costing more money.

I draw attention to exhibit 5 of the report, which I found quite interesting. When digging below the surface to work out why health boards are running out of money and why so many of them face deficits and are borrowing money, I read about “prescribed drug costs” and “staff costs”, which goes back to my first question about pay increases and what is driving them. Has Audit Scotland done a piece of analysis on the main drivers of the current situation? Is it simply due to pay awards and the increased cost of drugs from pharmaceutical companies, or is there something else that we are missing?

You have segued nicely into my next question, which is on delayed discharge. The report sets out some quite stark figures in that respect. On average, around 1,800 hospital bed days are being used up by people who should not be in hospital—and that is every single day. That equates to around 666,000 hospital bed days per year being used up by people who should not be in hospital. In fact, at its peak, the figure sat at over 2,000 hospital bed days.

That is creating problems—it is creating capacity issues and issues down the line. It is also creating issues for the patients themselves; at the end of the day, there are people—sick people—involved in all of this. Nobody wants to be in hospital when they do not have to be there, and there are people in hospital who do not have to be there—it is as simple as that. Is there any evidence that the Government is tackling delayed discharge, given the number of very high-profile promises that it made to reduce or, indeed, eliminate it? These figures seem to be going absolutely in the wrong direction.

James Dornan raised some important issues there. I want to carry on with that theme, and particularly A and E. As has just been mentioned by one of your colleagues, Auditor General, we are sitting at around 70 per cent of the target of being admitted, discharged or transferred for treatment within four hours. However, we know that there is a huge disparity across the country in how quickly someone will be seen, depending on where they live and the hospital that they are taken to. In NHS Forth Valley and NHS Lanarkshire, that figure is as low as 54 or 55 per cent of target, which is shockingly low. However, NHS Tayside and NHS Western Isles are at 90 per cent and 96 per cent respectively.

I can speak only from my own experiences. In my health board, my local hospital is Inverclyde royal hospital, and the figures there are quite stark. There has been an 8,000 per cent increase in people waiting in A and E for more than four hours and a huge increase in those waiting for more than 12 hours. Is there any understanding of why there are such huge health board disparities in NHS A and E waiting times?

I mention that because your report highlights that, in June 2019, 250 Scots were waiting for more than two years for in-patient treatment, and the figure has jumped to 7,100. Even just a small percentage of those people who are waiting and waiting for treatment might not make it—that is a piece of statistical analysis that one can do. As a percentage of 250, the figure would, I hope, be relatively low but, as the number waiting nears 10,000, you are talking about hundreds if not thousands of people not making it.

I guess that the point that I am raising is whether we should look at that. Could a piece of work be done on needless mortality in Scotland as a result of horrendously long waiting lists?

How many people have died while on an NHS waiting list?

I was not expecting to come in so early. Good morning to our guests.

I want to look at the bigger picture, so let us take a top-level approach to this. In your opening statement, Auditor General, you painted quite a stark picture of Scotland’s NHS. Despite a 2.5 per cent real-terms increase in funding from central Government, outcomes and outputs seem to be poorer and, in many areas, getting worse. Fewer patients are being seen, waiting times are getting worse, there are further delayed discharges from hospitals and, of course, there are the A and E waiting times—all of which we will come to in this session.

I suppose the logical question is: how on earth can the Government be spending more and more money on a public service but things be getting worse? In your opinion, what are the main drivers of that?

Do we have too many NHS boards in Scotland?

That is the point, though. You talked about the two areas where you can get additional money. The first is via the block grant, which presumably is either money that has been pre-promised from the UK Government through top-up funding from the UK budget or Barnett consequentials due to decisions that have been made in Westminster, or block grant asks of the UK Government, which are not guaranteed to be met—the two are very different. Alongside that sit revenue projections from tax intake under devolved taxation. What happens if neither of those increases or if there is no likelihood of them increasing? For example, early projections show that the tax increases announced in yesterday’s statement are less than £100 million, so it is nominal and nowhere near enough to scratch the surface of the spending commitments—the cash spend commitments. Surely the only other option would be for portfolio increases that happen in one area to require cuts in other areas. In other words, to balance the books, the money is just shuffled around from one set of portfolios to another. Either you have new money or you are just shuffling around existing money. It is very hard to determine which it is, and I guess that that is what I am struggling with.

You said in your last answer that the report highlights that social security spending will be £1.5 billion more due to devolved spending decisions, which again are policy decisions for policy makers. I understand that, and I am not asking for comment on the policy itself, but the facts are that they are spending more than they are getting in that portfolio. Presumably, that is unsustainable—the money must come from somewhere.

Just before I bring in Richard Robinson, I have to wonder whether we have a problem here. All the news headlines last night were about this particular policy, which I will not comment on the specifics of; however, despite all the focus on that policy announcement, we have since discovered that we do not know how much it will cost, if it is passed as part of the final budget and implemented. In fact, there is some dispute over those costs.

How can ministers stand up in Parliament or go on TV and say, “We are introducing this policy but no one has a clue how much it costs”? Any estimates that there might be—and we have heard from one independent source that it might cost £200 million to £300 million per annum—have not been fed into the budget process and therefore not been factored into the wider budget assumptions. What if you were to do that with every policy and just announced what you like? Having nothing in the small print that says, “This is how we came to that number. This is how much we as a Government know it will cost the public purse” does not feel like a sustainable way of running a budget in the long term.