Chamber and committees

So you are recommending that the structure of oversight of the health service change a bit to facilitate that. I realise that we were due to speak to other witnesses, too, but does that include the integration joint board structure? Would you recommend any changes on that front?

Thank you.

Thank you. That was helpful.

Obviously, there is a question to be asked about medium and longer-term planning for the economy; indeed, you cited that in your response to Michael Marra. The gap between Scottish Government projected expenditure and the tax take is a very serious issue, and I think that it focuses the committee’s attention on two questions. First, what is the scope for serious public sector reform that would help to address the problem? Secondly, how can we increase the tax take?

On the first of those issues, do you have suggestions for the most likely areas of public sector reform that could help with things, given the fact that there is almost certainly no scope to reduce spending on health, social security and social care? Indeed, as your own estimates have shown, spending on those areas is going to increase very substantially. What scope is there for public sector reform that could really help with that side of the equation?

The second aspect of my question is about tax revenues, which you have mentioned. There are ways to increase tax revenue by changing tax rates and thresholds and so on, but there is a question around the change to tax structures. A debate is going on down south just now about whether inheritance tax should be replaced, and we have had lots of debates up here about whether council tax should change, and so on.

I go back to the analysis, of which you are aware, around other countries that have changed their tax structures. Is that debate an urgent one to have here in order to address some of the concerns that we have about a weakening tax return?

Good morning. My questioning will focus on two areas. The first is about the frustration that I think we all feel about the different timings of the various forecasts that underpin strategies—whether it be those for the medium-term financial strategy or any other set of forecasts—and how the OBR and the SFC forecasts relate to the different timings in the budget cycle. That has an impact on the projections that can be made, given the data at that time. Is there scope to bring the timings of the forecasts slightly closer together so as to make things easier? I am sure that the OBR and the SFC would welcome that as well.

On the discussions about the forthcoming new fiscal framework, which will replace the 2016 version, are you aware of any dialogue about the forecasting element?

Just to finish off on that point, at your breakfast in the Parliament event some weeks ago, we focused on the potential high-growth areas of financial services, renewables, digital industries and technology. Are there other areas of the workforce where we have a chance of better, higher-paid jobs that will widen that tax base?

You said something very interesting about some people in the workforce taking a territorial approach. The same is also true of patients and families, who get very attached to their local hospital or medical service; indeed, we have seen what can happen when there is any hint that a hospital will be closed or that certain parts of it will be shut. However, you are correct to say that, for the benefit of medical services in the future, that is exactly what will have to happen to make the system more efficient. Given the nature of the reform that is needed, do you have any suggestions for what we should do to bring the public with us? I think that that will be a very difficult challenge.

You are, in effect, saying that the better decisions—and the ones that will probably be more accepted by the public—will be those made by clinicians and medics rather than by administrators.

In relation to the Covid era, it is interesting that, given how serious the situation was for everybody, decision making in hospitals was pretty effective, because clinicians decided how they had to run the wards. It provides quite an interesting lesson for the future, as it shows how incredibly important clinicians and medics will be in changing the health service’s whole set-up. I am interested in hearing your views on how easy it is in modern health services to ensure that the medics, rather than the administrators, take these decisions.

I am really interested in that. Reading the room, I can see that the potential for change is considerable, but there are quite a lot of difficulties in the way. We need to work out how we might address those.