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Good morning to you, Mr Boyle, and to your colleagues. In the past, you have said to this committee that you will not wait until the huge piece of public policy work that is the national care service is created before you start to audit it and to analyse the numbers around it. In your report, you warn that the national care service will place a huge strain on the health and social care budget. Obviously, concerns have been raised within the Parliament, particularly by the Finance and Public Administration Committee, in relation to the financial memorandum that accompanies the bill, which is on pause. What is your understanding as to why the legislation has been paused? Is it to look further at the numbers?

The national care service envisages a significant role for the private sector; potentially, some have argued, a greater role for the private sector if local authorities step back from that. The true cost of care seems to be the fundamental issue. I looked at some numbers. The national care home contract rate is £832 a week and a 25 per cent increase takes it up to about £1,040 a week. Private sector care home providers, whom the scheme is meant to incentivise to free up capacity in order to address delayed discharge, argue that that still falls short of what they perceive to be the true cost of care, given that they are contending with the cost of living crisis, higher energy bills and staffing cost pressures. Is it part of the problem that, until we identify the true cost of care and therefore properly fund care—particularly for those who are not self-funding—and remove the element of cross-subsidy, we will never get the capacity that allows us to aggressively bring down those delayed discharge figures?

The first annual progress report was in October 2022, and the first milestones of increased activity fall into 2023. Is it fair to say that, if you were creating a dashboard of those milestones of increased activity, they would still be flashing red? Do we need greater transparency around those, given that that progress and recovery was meant to come to fruition this year?

Obviously, we understand that social care and the NHS are inextricably linked. Your report states that the Scottish Government’s NHS recovery plan was not informed by detailed and robust modelling, nor were NHS boards involved in setting the ambitions of the plan. It further states that the Scottish Government is undertaking an exercise to model capacity across the whole health system. To what extent are NHS boards involved in that modelling process? Should it also include all elements of the social care sector to ensure that we have the capacity for that displacement?

Exhibit 2 of the report highlights the quite considerable increase in delayed discharges. Mr Clark, you identified that action needs to be taken now to remedy some of the issues. The problem of flow through the health service is down, in large part, to delayed discharges, which come down to capacity in the social care system. The Government has announced plans to purchase 600 interim care beds, with a 25 per cent uplift in the national care home contract rate. Have you calculated how sustainable and effective that relatively short-term intervention might be? Will it deliver value for money?

When we get the 2023 progress report, would it be prudent for us to press for greater transparency and more detail on what is actually being achieved?

Mr Kidd referred to the private sector and you mentioned that the evidence was anecdotal. There was the BBC “Disclosure” programme. Again, it was a survey, so we cannot necessarily put a lot of store by it. Nevertheless, it found that one in five people on NHS waiting lists had had some contact with the private sector over the past 12 months—it was something broadly of that order. Is it worth interrogating, perhaps, the size and the use of the private sector at the moment? Would that read through to some of the pressures that we see in the NHS?

I am thinking particularly?again, anecdotally?about my postbag, and this is probably true of colleagues’ postbags. Many people, when they have their first clinical appointment in relation to the treatment of orthopaedic issues or early-stage cataracts, are told, despite your saying that the NHS is open, that it will take three to five years for that treatment. They automatically pivot to the private sector if they can afford it and that obviously undermines the fundamental principles of the NHS.

I am concerned that, if there is a growth in people electing to do that for those specialisms, you might see staff drifting towards the private sector. While that may bring down waiting lists in some senses, it also means that those with the means or the borrowing capacity to do that will access healthcare far more quickly and will therefore not reach the same level of acuity as those who are not necessarily able to do that. Is it worth taking stock of whether there has been some shift to the private sector, because we will, at some point, undoubtedly have an issue in relation to the capacity of the NHS workforce and its waiting lists?

Thanks. The report highlights that the national care service, if it were to proceed, would require

“a significant unknown financial commitment to be met from the Scottish Government’s health and social care budget.”

To what extent are you concerned about the Scottish Government’s ability to meet its spending commitments in relation to the NCS and the impact that that may have throughout the healthcare system in Scotland?

For the public, elected members and board members to have confidence in the system, we must see sustained improvements in performance. Your report states that the commissioner’s office is planning to introduce performance indicators to track complaints handling, which will be introduced by March this year. Is that work going according to plan; will the deadline of March 2023 be met?

I have a final question that, again, asks for a somewhat crystal-ball projection. What would be an acceptable level of backlog, when the commission is compared with similar institutions?