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I hope that, in my answers, I did not create the characterisation that Mr Johnson has put to me. In terms of formal statutory accountability, that may well be the relationship, but, for a range of organisations, there are many other channels of accountability. For example, health ministers undertake annual public scrutiny of individual health boards, which members of the public can watch and engage with. A variety of accountability mechanisms can be put in place in that respect.

Going back to 2007, I recall that we took steps to declutter. We removed a range of public bodies and we passed the Public Services Reform (Scotland) Act 2010, a consequence of which was that further rationalisation work was undertaken. However, over time, different reforms took place that moved in the opposite direction. There is an argument for keeping such questions under review and considering whether further actions are required.

When we undertake structural reform, we must always be aware of the likelihood of disruption to service delivery. I was not a member of Parliament at the time of the local government reorganisation in 1995-96, but I remember that, during that period, it felt as though there was more focus on the reform than on aspects of service delivery. We must be mindful of those questions when undertaking structural reform.

I do not agree that the idea of prevention is not well understood or well applied. I think that the principle of prevention is clearly understood. I have given the committee the example of early learning and childcare. I think that it would be widely if not universally accepted that early provision of formal engaged learning and childcare opportunities for children is to the advantage of those children and will give them the best start in life. That is an example of a programme that has been delivered, and our local authority partners have been 100 per cent joined at the hip with us on the implementation of that programme. Once we agreed the financial arrangements, there was full-on co-operation. I think that that has been a universally accepted policy approach. That is one example of prevention.

Another example that I would give is in the field of youth justice. Ten years ago, we were seeing high numbers of young people going through the youth justice system, being prosecuted and ending up with damaging criminal records. Essentially, our justice colleagues—not just in the Government; this was a whole-systems approach involving community justice authorities around the country and a range of third sector organisations—deployed early intervention. The work of organisations such as the Scottish Violence Reduction Unit, for example, was supported to ensure that we made the earliest possible intervention where we saw young people proceeding in a direction that was going to lead to damage to society and, crucially, to their own wellbeing.

Over the period between 2008-09 and 2019-20, there was an 85 per cent reduction in the number of 12 to 17-year-olds who were proceeded against in Scotland’s courts. Why? Because we have put in place earlier intervention to avoid the situation becoming so aggravated that it would merit someone going to court. For me, that is probably one of the best examples. There will be young people among them who can make a contribution to our society, but they have faced difficulties and potentially got themselves into trouble at some stage. To be blunt, a different approach from the state has resulted in those young people being able to make a more positive contribution to society than would have been the case in the past. That is about putting the principles of the Christie commission into practice in an operational way.

To be frank, that is the $64 million question. My response is largely about the thinking that is in the Covid recovery strategy. We have been explicit in that strategy that the atmosphere, ethos and thinking that brought public servants together in spring 2020 to deliver solutions are now required to meet the wider fundamental challenges in the Government’s programme of addressing child poverty and the climate emergency.

Those two substantive themes will not be resolved in neat little compartments. That will require collaboration and co-operation, the sharing of an ethos and the transcending of boundaries. At the heart of the Covid recovery strategy, we make the point that that is what we need to encourage.

What I am trying to do in the Covid recovery strategy is empower people and give them encouragement, authorisation and permission to take that approach. I do not think that we can underestimate the degree to which people might feel the need to be given permission. I should maybe have included that point in my answer to Mr Lumsden’s questions. The sense of needing to be given permission might be an impediment to people making progress in the way that we are discussing.

Highland Council decided that, with regard to the integration of health and social care, the health board would take responsibility for either adult care or children’s care and the local authority would take responsibility for the other one—I cannot remember which way round it is. When I was speaking to a care worker in the Highlands, I asked what the biggest impact of that had been for her. She said, “It means that I can do what I need to do for the member of the public I am supporting without fear of being bollocked for spending health board money on a local authority priority.” That is about permission. For that woman, all this grandiose architecture meant that she could focus on the member of the public she was supporting and do the right thing as opposed to thinking, “Well, doing this will involve spending money that is not really in my bailiwick, because the local authority or whoever should pay for that.” We have to get beyond that kind of thinking.

It is frustrating, and it is difficult to justify why that is the case. That applies to examples of not only innovation but routine service improvement, when relatively straightforward steps could be taken to improve performance but are not widely taken by all public authorities.

We take a number of steps to address that. For example, our work through the Scottish Leaders Forum is designed to bring together public authorities to enable them to learn lessons and improve performance. There are organisations in the national health service that are designed to deliver improvement across all boards. Local authorities have collaborated to establish the Improvement Service, and they draw on the lessons from it. The Government funded the What Works Scotland venture, which was designed to apply academic analysis to work that was undertaken to implement the Christie commission recommendations and to share that learning more widely across public sector systems so that organisations can tap into it.

As you will appreciate, ministers have—understandably—more or less influence in certain areas of policy and delivery. Ministers do not have operational control of local government, so it is for local government, through democratic decision making, to decide how to respond to such challenges. With other public bodies, such as health boards, ministers have much more direct opportunity to place obligations on them to perform.

I think that we could do with a broad range of people who have different expertise and capabilities coming forward for our public bodies.

I do not think that that stops the focus on performance in general, but it might be an obstacle to generating the necessary shift in activity or focus to enable that. There can be a mismatch between the things that we measure and the things that we want to achieve, which are often two different things.

No. I will continue with my Scottish Enterprise example. If I sent a letter of guidance to the chair of Scottish Enterprise and then saw that the organisation was not going in the direction that I wanted, the first conversation would be between the chair and I, in which I would ask what was going on.

The board is accountable for the direction of the organisation and delivery of its purpose. The SMT has to turn that into operational reality. The board is just as responsible for and accountable to direction from ministers as it is for addressing issues that are entirely the statutory right of ministers to set out.

There has to be a balance in all those considerations. There is a necessary place and purpose for accident and emergency services to operate in a highly efficient fashion, because that will deliver the best patient outcomes. The challenge is to ensure that the system works more effectively, so that people are able to get accident and emergency services quickly when they need them. Although we support vibrant and effective A and E services, we also have to have effective social care packages to avoid cases ending up in A and E unnecessarily because no social care package was available for the home.

The lesson is that we need to consider the questions on a whole-system basis. When I was questioned about the Scottish Ambulance Service and answered for the First Minister a few weeks ago, all my answers were about the fact that the challenge is a whole-system challenge. It is not just about the compartment that we call the Ambulance Service. What goes on in a range of other compartments in our public services affects the Ambulance Service compartment. Collaboration and co-operation of the style for which the Christie commission argued are central to resolving some of the more high-profile questions, such as ambulance and A and E waiting times.

Compartmentalised budgeting is undoubtedly a challenge. Another challenge is lining up procurement processes so that all organisations arrive on the same day, because different organisations might have different levels of financial security.

One question is whether there is the necessary perspective and vision to imagine such concepts. I dare say that, when the Midlothian and Tillydrone facilities were being conceived of, there might have been a wee bit of people thinking, “Oh really? Are we sure that we can pull this off?” Vision and commitment are needed to make such examples happen.