Chamber and committees

It would be great to have any additional updates that you can provide.

It is interesting that much has been mentioned about workforce issues, and we have talked in great detail about the importance of executive leadership. The other key finding from the external review of corporate governance is about the

“root cause of many of the significant challenges”

that you face as a health board. The review states that one root cause is

“the failure to agree an appropriate business model for the delivery of integrated health and social care services”.

We have not spent a lot of time on that aspect this morning. Have things improved?

Appendix 2 of the report is on the delivery schemes. It seems to be a complicated and complex subsidy environment. There are a number of schemes. We have warmer homes Scotland, which is delivered by Warmworks. We have area-based schemes, which are delivered by local councils. We have Home Energy Scotland grants, which are delivered by the Energy Savings Trust, and so on. The number of households that are getting proper conversion of heating systems out of that is in the tens of thousands, as opposed to the hundreds of thousands or millions.

It seems to be quite a complex landscape, as other members have mentioned. Could it be simplified? The risk is that if you leave things to the market alone and people’s only exposure to accessing improvements is via the private sector advertising those schemes with a view to making profit in their own way, it becomes quite a dangerous environment for the consumer.

That is based on the assumption that we will have the people to do the work. As you said, there is a huge number of people out there who can install new gas boilers, but there will need to be a marked shift to installing new technologies and maintaining them on an on-going basis.

There has been a fair amount of pushback from the industry about what is on offer to incentivise it to retrain and reskill staff if the market does not exist. It is a bit of a chicken-and-egg situation, of course. Do you think that the Government is acutely aware of that? Do you think that the plans that it has produced to ensure that we have the people to carry out the transition are robust?

That is fine. My parting question is for Ms McCusker. It is your last day in the job as chair. What would your advice be to the incoming chair?

It is interesting that you talked about the various incarnations of the work in this area. Following the days when solar panels on roofs were the big thing, people were told, “We’ll come and insulate your home. There are some grants available for that, and you can top it up yourself.” We are now talking about a root-and-branch approach, which involves people taking out their current heating system and replacing it with new technologies, yet most people probably do not understand what those technologies are. Does that open up any risk of increased exposure to rogue companies, scams, fake grant scenarios, misleading advice being given to consumers and so on? Should the Office of Gas and Electricity Markets pay attention to that?

Mr Murray, did you say that you are the longest-serving member of the board or just the longest-serving member who is here this morning?

Please do not take this question personally but, as the longest-serving board member here, you saw your health board escalated to level 4. That is one off from level 5, which is the most serious level and effectively means that the Government has no confidence in the board at all to deliver effective and safe care to patients. Level 4 is almost there. How could the board—collectively and individually—over a number of years have let things get to the stage at which the Government has had to intervene in such a fashion? Surely, the board, on an on-going basis, would be monitoring and auditing processes, outcomes and practices. If it was a private business, it is difficult to see how you would be sitting here this morning.

We are very short on time, and I want to move on. Surely the proof would have been in the pudding, and as Mr Simpson said, outcomes for patients are what matter. Could you see a pattern of deterioration in outcomes? For example, your four-hour emergency access compliance is down at 50 per cent, which is way below the Scottish average and that dropped considerably over a period of time. Surely, all those performance issues in relation to the CAMHS statistics, the out-of-hours GP access and the 18-week waiting times for referral for psychological assessment would have been massive red flags to the board that it was in danger of escalation.

Can I move on to the present day? We could spend a lot of time on retrospect, but I am sure that lessons will be learned and that there is a lot of personal regret in the executive leadership team.

Ms Croft, where are you currently with some of the service improvements? It is still looking quite grim for patients in Forth Valley with regard to waiting times across a number of key metrics. At the risk of my questions needing a lengthy answer that we do not have time for, what are some of the steps that you are taking right now to improve, for example, performance with regard to the four-hour A and E turnaround and 18-week referrals for mental health assessments? What are the limiting factors? We have talked about workforce and finances, but what key barriers exist right now to making immediate improvements so that you can de-escalate out of level 4?

It is at 64 per cent, against a target of 80 per cent, so it is still—