Dr. Tom McDonnell:

I agree with the Chair on design and deliver. It is a model we need to think about going to. I am sure there will be a paper that could justify it; I do not see how it would not. We need to change the model. We need consistency in terms of the people doing projects. It cannot simply be the case that when a person is building the children's hospital, they are then moved to a different part of the Civil Service and somebody else does the next project. We have to keep the skills in place. That is true even with the economic evaluation service, where we want to keep economists doing that work throughout their career. It is problematic.

There are what we call soft budget constraints in government because Governments do not go bust in the traditional private sector way. They can go bust like in 2008, but they do not quite go bust. A Government is not a business in that sense. It is also not a Government's money per se. Those are all concerns. To resolve the soft budget constraint issue, moving to a type of design and deliver model is necessary. It is something we will have to do.

The adjustments out to the 2030s and 2040s, including for an ageing population and all of the other constraints, would ideally not all be done on the taxation side. Ideally, we will be able to use new technologies such as artificial intelligence in healthcare and digitalisation of the health service to create enormous savings. In terms of capital budgeting, we have to seriously consider how we do all of these things.

We need to learn from the children's hospital. It does not need to be about blame. Yes, mistakes were made. Let us find out what they were. We do not have to name names. We need to find out what the mistakes were, learn from them and decide what to do in future. If necessary, we can bring in people from Europe or other countries around the world that have done this very successfully and find out how they did it as a state. They have this same constraints as we do, and they could do it but we cannot. We can ask what is being done differently. It may be to do with our legal system or something else. If it is to do with our legal system, that could, of course, be problematic, but that is what legislators are for.