I will make a few introductory points, if I may.
I will start with the share of the budget: how much health spending accounts for as a share of the Scottish budget, which is an issue of some interest. The share appears to drop from 33.8 per cent in 2014-15 to 32.5 per cent in 2015-16, but that is somewhat misleading. In fact, the share stays pretty much the same if we discount the annually managed expenditure on Scottish pensions provisions. There has been a huge increase in the AME budget for pensions, which apparently results in a reduction in the share of health spending, but that is to do with something that is not really under the Scottish Government’s control.
I will talk a little bit about spend per head in Scotland. Between 2008-09 and 2012-13, health spending in Scotland, compared with that in England, has gone from a higher spend, with a margin of 14.3 per cent, down to a margin of 11.7 per cent, so there has been something of a fall in the spend of Scotland relative to that of England. At the same time, there has not been a huge amount of change in Scotland’s overall extra spending. In 2008-09, in Scotland’s overall public expenditure per head, the margin over England’s overall public expenditure per head was 18 per cent, which was considerably more than the margin in health spending. In 2012-13 it was 19 per cent, so it has not changed much. However, there has been a bit of a change in respect of health spending. I am happy to take questions on that.
10:45
I will say a little about targets. Andrew Walker comments on the issue in his submission, so I will be brief. I consider that targets are a snapshot of experience and that people are interested in the broader perspective of the health service, their experience in it and the quality and availability of the care that they get. I would like there to be broader public involvement in how we come to decisions on what we want from the health service. The Scottish universities innovation institute is doing an interesting project on wellbeing, in which we are considering how we might engage the public in the national performance framework to a greater extent than has been the case up to now.
As an economist, when I think about things such as the level of productivity in the Scottish health service, I look at the Information Services Division statistics, but it is difficult to figure out what is really happening. For example, how are costs changing and is the gross domestic product deflator—which is used in Scottish Parliament information centre publications and other publications to get to what is described as real spending in the health service—the appropriate measure of costs in the health service? It is not entirely clear to me that there is sufficient evidence to back that up in Scotland.
On the mix, or interaction, between social care and health, it seems to me that we are in for an extended period in which local government budgets will come under increasing pressure. Health budgets are likely to be protected to a greater extent than local government budgets, which will put more and more pressure on the interface between social care and healthcare. Therefore, it is important to make as efficient, and as well-evidenced, as possible the use of resources that go to that interface.
My final point is perhaps a little bit from left field. The See Me campaign has today produced a document asking for an end to the stigma around mental health issues. It seems to me that Scotland is perhaps a little behind the curve in its focus on mental health, in relation not just to stigma and to wellbeing—the evidence is absolutely clear that mental health is one of the most significant predictors of low levels of wellbeing—but to the economic case for investment in mental health services, which has been made strongly south of the border, where the National Institute for Health and Care Excellence has recommended a number of policies that relate to a switch towards mental health services. Now that the Scottish Government has control over at least a proportion of its income tax revenues, and that proportion will perhaps increase, there is a case for considering whether investment in more mental health services capacity in Scotland would lead to a larger increase in income tax revenues than would, say, increased investment in childcare, which is one proposal that seems to be out there.
I will end on that slightly controversial point.