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Is the Government too easily put off course by events? It has talked about the general election. It seemed understandable to me, noting the advice that was given by the permanent secretary, that the Government should not publish the MTFS. I am not convinced that many of my constituents would have been influenced as to how to vote by the MTFS, to be honest. There is a difference between delaying something because of a general election and still waiting for it a year later. Even if there is an element of flexibility for certain events, should the arrangements be less flexible than they currently appear to be?

Thank you very much. The first thing that I want to talk about is the significant difference of opinion between you and the Institute for Fiscal Studies. In your submission, you said that

“the Scottish Government should publish its financial and infrastructure medium-term strategies at the earliest opportunity.”

However, in his evidence, David Phillips from the Institute for Fiscal Studies, said that

“the Scottish Parliament has welcomed and indeed pushed for this timing”

which is May 2025,

“as the earliest practical opportunity to publish an MTFS. In my view, this publication date is a mistake. I would have preferred to see the MTFS published after the summer recess, and after the UK government’s multi-year Spending Review (set to be published less than two weeks after the MTFS, on June 11th)”.

Why do you think that the MTFS should be published at the earliest opportunity when the IFS, which, unfortunately, is not giving evidence this morning, so we cannot ask it directly, thinks the opposite?

In paragraph 4.9 of your report, you say that

“There has been a decline in Scottish healthy life expectancy since 2014-16.”

That was based on the 2019 to 2021 figures, and Covid may have had an impact on those figures. Given that, for example, smoking has decreased and younger people are not the boozers that people in your generation were, Graeme, why is that happening? Think of the rubbish that we used to get fed in the 1960s and 1970s, compared with the quality food that we have now. The air is also cleaner, and all the rest of it. Is it because of mental health or other issues? Why is it that the healthy life expectancy has not continued to improve? Poverty is also lower than it was a few years ago.

In relation to the funding overview, figure 3.1 in your report and the detail underneath it show that funding for the Scottish Parliament will grow in real terms from £65 billion in 2029-30 to £159 billion in 2074-75 but that its expenditure will grow from £65 billion to £160 billion, so there will be a difference of only £1 billion, even though expenditure will increase astronomically—it will more than double—during that time. You have spoken about people having higher expectations in relation to the quality of services, but how can we possibly deliver that massive increase in spending and revenue if we do not have productivity growth over the next 50 years?

The number of patients in that case is so small that that may not happen. It is not like the situation where a video recorder used to cost a thousand quid and, five years later, it was 20 quid. I am not convinced that that will always happen in certain areas where rare, or relatively rare, conditions are involved.

The next agenda item is an evidence session with the Minister for Public Finance on the draft Land and Buildings Transaction Tax (Group Relief and Sub-sale Development Relief Modifications) (Scotland) Order 2025. The minister is joined by the Scottish Government official Laura Parker, LBTT policy lead in the directorate for tax and revenues. I welcome our witnesses and I invite the minister to make a short opening statement.

What impact will that have on treatments? I chair the cross-party group on life sciences, and we had a presentation from the chief executive of Moderna, who came all the way from Texas for the meeting. He was talking about messenger RNA being used for individual cancer patients so that a cure is developed based on someone’s specific DNA, as opposed to anyone else’s. It costs an absolute fortune—although he did not put a price on it, of course, because it is still at the development stage. However, it looks very promising, particularly for people who have cancer that is at a very advanced stage.

We also have things such as Ozempic, which could have a cost benefit. It might cost £1,500 a year, but if it prevents heart attacks and strokes, it could potentially save a lot of money in the long run. How do we balance those types of developments through a cost benefit analysis? As another example, a new cure for sickle-cell anaemia has been developed out in Roslin—apparently it costs £1.6 million per patient.

Some treatments will be very cost beneficial, and there are also quality-of-life issues; we are talking about individual human beings. Nevertheless, from an economic point of view, when you are forecasting in an area that is as complex as health, how do you balance the costs and benefits of those different innovations?

One of our concerns, when we see that potentially up to 55 per cent of the Scottish budget will be spent on health by 2075, all else being equal, is the fall in productivity in healthcare.

As you say in the report, productivity in manufacturing, for example, through technological innovation and so on, is a lot easier to increase than productivity in areas that are labour intensive, such as healthcare. We have seen a quite substantial reduction in the productivity of the health service across the UK since the pandemic. What impact has that had on your projections, and do you expect that reversal to be turned around over the next five or 10 years?

Despite that, there seems to be less focus on that issue than there has been in recent years.

Are there any further issues that we have not covered that you want to emphasise?

I have another couple of questions.

Last week, Professor David Bell said that further improvements can be made, including to provide clarity around regular in-year transfers in the Scottish budget. When we look at the spring and autumn revisions, my colleagues and I often raise the issue that, every year, we get the same transfer of resources from one budget line to another. We have speculated about the reason for that, but what is your view?