Hansard

09:30

The Convener Lab

Our principal agenda item is further consideration of the Auditor General’s report, “NHS in Scotland 2025: Finance and performance”, which is an annual audit...

Caroline Lamb (Scottish Government)

Good morning. I am grateful for the opportunity to be here to respond to questions on Audit Scotland’s report, “NHS in Scotland 2025: Finance and performance...

The Convener Lab

Thank you. For the record, do you accept the findings and recommendations of the Audit Scotland report?

Caroline Lamb

Yes, and we will be working towards addressing the recommendations.

The Convener Lab

I want to ask about an item that you touched on towards the end of your opening statement: the support and intervention framework that you operate. You are r...

Caroline Lamb

As you rightly say, NHS Ayrshire and Arran has been in escalation at level 3 for a number of years. That has meant that the Scottish Government has been supp...

The Convener Lab

What is the point of a support and intervention framework and the Scottish Government supporting and intervening if that makes no difference to a health boar...

Caroline Lamb

Yes, of course—the purpose of the support and intervention framework is to support boards to improve.

The Convener Lab

But it has not happened in this case, has it?

Caroline Lamb

It has not happened in this case, which is why the board has been escalated to a further level. We have a number of boards that are escalated, and we monitor...

The Convener Lab

That has come after a considerable period of time in which there has been an escalated level that has not led to any change in performance.

Caroline Lamb

Yes, and that has not been without our providing additional support in an effort to change that. We recognise that the issues at NHS Ayrshire and Arran are l...

The Convener Lab

We acknowledge that there has been a change in the leadership of the board. To an extent, that leads me to one of the overall points that is made in the audi...

Caroline Lamb

I do not think that that is strictly the case. I think that NHS Ayrshire and Arran has understood that it was escalated at level 3. When the previous chief e...

The Convener Lab

Can I take you to the other side of the argument? A number of health boards have never gone into financial deficit and have never needed to be escalated. The...

Caroline Lamb

It is clear that there are different challenges and issues that need to be addressed across Scotland. You are right. As well as responding to financial balan...

Fiona Bennett (Scottish Government)

I will just briefly add that we have moved away from the old brokerage system to the deficit support funding system to make it a more equitable process. All ...

The Convener Lab

Other members of the committee will ask about the allocation formula and so on.An issue that we have raised previously in evidence is that it would be one th...

Caroline Lamb

I agree. NHS Grampian was escalated not only because of financial performance but because it was an outlier in relation to performance in a number of areas, ...

The Convener Lab

I suppose that that begs a question about why it is necessary to rely on unannounced inspections by Healthcare Improvement Scotland to bring about the necess...

Caroline Lamb

I will ask Christine McLaughlin to give you a bit more detail. However, to be clear, within my directorate, through our national performance oversight group,...

Christine McLaughlin (Scottish Government)

I agree with the point that you are making, convener. Often, when a system goes out of balance, that manifests itself through the financial position, but it ...

The Convener Lab

That leads me on to my final question for this part of the discussion, which is about governance arrangements. It is not simply a question of you, from the c...

Caroline Lamb

You are absolutely right. The responsibility lies with territorial boards. The relationship between the non-executives and the executive team is particularly...

Fiona Bennett

There is also really good evidence of a level of collaboration across the boards, and I have seen that grow over the past year or so. There is a peer support...

The Convener Lab

You mentioned evidence; do you have evidence to support claims that new board members are being trained and that existing board members are being offered ref...

Caroline Lamb

That would be part of the assessment against the blueprint for good governance, but I will come back to you as to whether we have any data. I should add that...

The Convener Lab

Good. Thank you very much. I now invite Colin Beattie to put some questions to you.

Colin Beattie (Midlothian North and Musselburgh) (SNP) SNP

At our meeting on 7 January, the Auditor General highlighted the fact that we are now entering a cycle in which private finance initiative—PFI—contracts are ...