Committee
Public Audit Committee 04 March 2026 [Draft]
04 Mar 2026 · S6 · Public Audit Committee
Item of business
“NHS in Scotland 2025: Finance and performance”
Caroline Lamb
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You are absolutely right. The responsibility lies with territorial boards. The relationship between the non-executives and the executive team is particularly important. The non-executives need to get the right information to be able to hold their executive team to account. That is a really important part of our system. Even when a board has been escalated to level 4, it is still the board that is responsible for delivering the improvements that we expect to see.In order to support that, as you will be aware, we have “The Blueprint for Good Governance in NHS Scotland”, which is in its second edition. Boards have relatively recently been through a process of self-assessment against that, and they all have action plans that they are delivering. They are supported by a team in NHS Education for Scotland, which acts as a critical friend and looks across the range of self-assessment results that come back from boards, so that we are able to identify where themes are coming through and boards can learn from one another.We provide a number of supportive mechanisms to boards. In our recruitment, especially of chairs of NHS boards but also of non-exec members, we focus on being really clear about those roles and responsibilities and ensuring that board members take up training in relation to their roles.You are right that that responsibility is a really important part of our structures. We provide a lot of support to boards to help them to discharge that, but it is also something that we monitor through our performance management arrangements and the soft intelligence that we receive about how board meetings are functioning.
In the same item of business
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 ...