Spending on the NHS in Scotland has reached record levels and waiting times have improved, but the government’s record on the health service was lambasted following the publication of the latest Audit Scotland ‘report card’ yesterday.
Health spending accounts for 40% of all government spending, but a ccombination of increasing costs, staffing pressures and unprecedented savings targets mean that Scotland’s NHS boards are finding it difficult to balance demand for hospital care with investing in community-based services to meet future needare with investing in community-based services to meet future need, according to the latest Audit Scotland review.
Audit Scotland’s annual review of the financial health and performance of the NHS in Scotland recognises there have been improvements over time, such as increasing patient safety and reducing waiting times for hospital treatment.
The total health budget in 2015/16 was £12.2 billion. Although this increased by 2.7 per cent in real terms from the previous year, NHS spending is not keeping pace with increasing demand, rising costs and the needs of a growing and ageing population. This strengthens the case for changing the way services are delivered.
NHS boards struggled to achieve financial balance in 2015/16, and many used short-term measures to break even. Overall, NHS Scotland failed to meet seven out of eight key performance targets, though one of these was missed by a very small margin.
The report highlights a number of other significant challenges for the NHS, including:
- Increasing spending on drugs;
- The need for NHS boards to make unprecedented levels of savings in 2016/17, and a risk that some will not achieve financial balance;
- An ageing NHS workforce and difficulties in recruiting and retaining staff in some areas;
- Increasing spending by boards on temporary staff;
- A lack of workforce planning for new models of care to deliver more community-based services.
While the Scottish Government has published several strategies for reducing the use of hospitals and supporting more people in the community, most spending is still on hospital and other institutional-based care.
Caroline Gardner, Auditor General for Scotland, said: “Major challenges lie ahead for the NHS in Scotland. There are growing pressures on health boards which are struggling to juggle service delivery and progressing major reform whilst also managing considerable financial challenges.
“The Scottish Government has had a policy to shift the balance of care for over a decade but despite multiple strategies for reform, NHS funding has not changed course. Before that shift can occur, there needs to be a clear and detailed plan for change, setting out what the future of the NHS looks like, what it will cost to deliver and the workforce numbers and skills needed to make it a reality.”
Audit Scotland has made several recommendations in the report to support the Scottish Government and NHS boards implementing improvements.
Responding to Audit Scotland’s annual report on Scotland’s NHS, Health Secretary Shona Robison said: “Under this government there have been significant improvements in the performance of the NHS, the safety of patients, overall life expectancy and survival rates for conditions such as heart disease supported by a real terms increase in spending on our NHS.
“Scotland’s core A&E departments have been the best performing in the UK for the last 18 months, and 90% of all hospital patients rate their care and treatment as good or excellent.
“In addition, as Audit Scotland note, overall staff levels are at their highest rate ever.
“And as this report confirms, the health budget stands at its highest ever level, with close to £13 billion being spent in 2016/17. We have also committed to increase the NHS revenue budget by £500 million above inflation over the course of this parliament – which means that it will rise by almost £2 billion in total.
“However preparing the NHS for the challenges of the future is not just about additional funding, but also new ways of delivering services.
“That is why we have invested a quarter of a billion pounds in social care this year as part of our integration policy, and recently committed to an extra £500 million to shift the balance towards primary care services before the end of this Parliament.
“Our national clinical strategy sets out a new approach to services and the delivery of five new elective centres will help us to speed up treatment and meet the increasing demand that comes as a result of a growing elderly population.
“Also, in order to ensure we have an NHS workforce fit for the future, we will develop a new national workforce plan
“These are changes that will help to equip our health service to continue to deliver excellent and safe care for the people of Scotland in the years ahead.”
Opposition parties were quick to attack the government’s performance on health, however. Conservative leader Ruth Davidson said the SNP has ‘ducked the big challenges’ while Labour’s Kezia Dugdale described the report as a ‘grim diagnosis’.
The Tories said the SNP Government must urgently press ahead with key NHS reforms in the wake of today’s damning report into its failure to manage the health service.
Raising Audit Scotland’s report into the NHS at First Minister’s Questions, Scottish Conservative leader Ruth Davidson said the SNP had “ducked” the big challenges in its decade in power.
The party is now calling on the SNP to adopt Audit Scotland’s recommendations – including a move, backed by nursing leaders, to allow health boards to set budgets for three years, not just the year ahead.
Audit Scotland’s report revealed that “there is evidence of boards increasingly using short-term approaches to meet annual financial targets….through one-off measures”.
Speaking after First Minister’s Questions, the Scottish Conservatives leader said: “Ten years ago, Audit Scotland was raising these exact same concerns about the NHS. Countless times, Nicola Sturgeon has promised action. Yet, once again, another Audit Scotland report reveals that our NHS is in crisis. Under the SNP, the NHS has suffered a lost decade.
“Ministers have ducked, dithered and delayed the key decisions – too busy fighting a referendum to champion our NHS.
“The First Minister’s response today was to put her head in the sand and then point the finger at England. We need her to take responsibility, not pat herself on the back over the SNP’s failed record.”
Health spokesman Donald Cameron added: “Audit Scotland today make a series of important recommendations to help deliver the sustainable NHS we all want to see.
“That includes giving Health boards more long-term budgets so they can plan properly, and not scramble around to find savings at the end of every year.”
“These are common sense solutions that the SNP should have adopted years ago. They’ve been ignored because Health Ministers have been out campaigning for independence, not focussing on the day job.”
Labour’s Shadow Cabinet Secretary for Health Anas Sarwar said: “Today the independent experts at Audit Scotland published theit annual health check on Scotland’s NHS. It is a damning indictment of the SNP’s record in government.
“This expert report underlines what Labour has been saying for months – after ten years of SNP mismanagement our NHS is in real distress. The scale of mismanagement in our health service revealed by this report is utterly staggering.
On key tests the SNP is failing:
Only one out of eight key standarsd get pass marks from Audit Scotland
Nine out of ten nurses say their workload is getting worse.
One out of four GP surgeries say they are understaffed
Only a third of NHS staff believe there are enough of them to do their jobs properly
If doctors and nurses are telling us they aren’t getting the support they need we should listen.”
“Lbour has raised the unacceptable pressure NHS staff are under – and this report reveals that, thanks to the SNP, the workforce crisis is now so bad that private consultants can make £400,000 a year in our health service. The SNP called Labour liars when we said local health services were under threat – this expert report confirms that under the SNP the NHS id facing a cuts bombshell with key services facing the axe.
“That is why Labour would do things differently. We would end the sticking plaster solutions of the SNP and use the powers of the Scottish Parliament to stop the cuts, to invest in local services like social care to take the pressure off hospitals and NHS staff.”
The Scottish Greens say the Audit Scotland reporture, is proof of the need for more ‘preventative spending’. The party’s health spokesperson, Alison Johnstone MSP says the report shows that the government needs to make workforce planning a top priority to help prevent a crisis. The report highlights how most health spending is still focussed on “hospital and other institutional-based care”.
Lothian MSP Alison Johnstone said: “We know that the Scottish Government agrees with the Greens’ policy on greater preventative spending, but ministers need to turn warm words into real action. By preventing ill-health, we can ease the pressure on our NHS and if we invest in good health now, through everything from warm homes and safe walking and cycling routes to good food and a living wage, we can lighten the burden on health services.
“Recruitment and retention of qualified staff is a key issue, and ministers must prioritise planning ahead so we know what kind of jobs will be needed to cope with Scotland’s changing health. It’s a concern that although record numbers of people are employed in the NHS in Scotland, they are undoubtedly over-stretched. We will continue to press this case in the forthcoming Scottish budget.”
You can read the full Audit Scotland report here.
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