Tag: Audit Scotland

Reform of NHS key to pandemic recovery, says Audit Scotland report

The Scottish Government must focus on transforming health and social care services to address the growing cost of the NHS and its recovery from Covid-19.

Improving the NHS will be very difficult against the competing demands of the pandemic and an increasing number of other policy initiatives, including plans for a National Care Service.

The health service in Scotland is on an emergency footing and remains under severe pressure. There is a growing backlog of patients waiting much longer for treatment because of the response needed to Covid-19. That has made workforce planning and delivering on ambitious recruitment plans all the more important. But the Scottish Government has historically struggled to recruit enough people with the right skills.

The NHS’s ability to plan remains hindered by a lack of robust and reliable data, including workforce, primary care, community, social care, and health inequalities data.

Meanwhile the pandemic has increased the fiscal pressures on the NHS, which remains financially unsustainable. This is despite the Scottish Government allocating £2.9 billion for pandemic-related costs in 2020/21 and committing more funding in 2021/22 and beyond.

Stephen Boyle, Auditor General for Scotland, said: “Reforming the NHS is key to the Scottish Government’s pandemic recovery plan and needs to remain a priority. Putting Covid costs to one side, health spending is rising every year, meaning less money for other public services.

“There’s now a clear opportunity to do things differently by building on the innovation and collaboration we’ve seen across the NHS in the last few years.

“For that to happen, our leaders must take the public with them and involve them in the shift from care being delivered in hospitals to much closer to people’s homes. But better-informed policy decisions and services won’t be possible without better collection and use of data.”

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‘Serious failings’ at ethical standards body

“It is disturbing to see so many failings in an organisation, not least because it deals directly with concerns raised by members of the public”

Public trust in the body that investigates complaints about the behaviour of MSPs and councillors is now at risk because of serious failings in the way it is run.

The Commissioner for Ethical Standards in Public Life in Scotland (CESPLS) assesses complaints about the conduct of MSPs, local authority councillors and members of public bodies and then decides which to investigate.

Failings identified by the appointed auditor include:

  • an absence of openness and transparency
  • a breakdown in key relationships with stakeholders and within its own office
  • no effective scrutiny or challenge which might have flagged up issues earlier

The Commissioner’s Office has since accepted 22 recommendations made by the appointed auditor and has made progress in addressing issues raised.

Stephen Boyle, Auditor General for Scotland, said: “It is disturbing to see so many failings in an organisation, not least because it deals directly with concerns raised by members of the public.

“It is vital that progress underway continues and that the recommendations made by the auditor are implemented.

“The overarching risk is that there will be a loss of public trust in the ability of the Commissioner’s Office to properly investigate and consider complaints made against individuals in public life in Scotland.”

STATEMENT FROM THE ETHICAL STANDARDS COMMISSIONER

Audit Scotland today published a Section 22 report* regarding this office (as above). The report and further details can be found on Audit Scotland’s website: Report: The 2020/21 audit of the Commissioner for Ethical Standards in Public Life in Scotland.

The report has been made in relation to serious issues identified in the audit relating to 2020/21.

Ian Bruce was appointed as Acting Commissioner on 20 April 2021 and has instituted a series of remedies. These include:

  • the production of a revised strategic plan for the next three years, which now incorporates the values that were missing from the previous version and clear statements of intent about how the office will fulfil its statutory obligations in accordance with the expectations of the Parliament, public and stakeholders
  • a new biennial business plan covering all office functions and addressing each of the auditor’s recommendations
  • the reinstitution of Senior Management Team (SMT) meetings in accordance with previous good governance arrangements and re-eagement with our Advisory Audit Board, whose members are drawn from the independent members of the Scottish Parliamentary Corporate Body’s AAB
  • the recruitment of three new Investigating Officers and a new Corporate Services Officer, to ensure all office functions are appropriately covered
  • meaningful re-engagement with the SPCB and on-going communications with the SPCB and the Parliament’s Standards, Procedures and Public Appointments Committee to keep the Parliament updated on our situation and plans
  • meaningful and on-going engagement with all stakeholder organisations, including the Standards Commission for Scotland, the Convention of Scottish Local Authorities (COSLA), the Society of Local Authority Lawyers & Administrators in Scotland (SOLAR) and the Society of Local Authority Chief Executives (SOLACE)
  • ensuring that the directions issued by the Standards Commission are complied with.

Progress to rebuild the organisation and its relationships with stakeholders is well underway.

The Acting Commissioner Ian Bruce stated: “I am grateful for the auditors’ work on the review and have welcomed their recommendations, the majority of which are addressed in our strategic and business plans.

“I have been grateful, also, to the SPCB and the Standards Commission for Scotland for their support since my appointment and their recognition of the many changes that I have already made.

“I and the entire team are dedicated to working in accordance with our new plans and the new values that we have adopted as an organisation. It is incumbent on me and on all of the staff to earn the trust of the public and the many stakeholder organisations that rely on our effective operation as an office. We are absolutely committed to doing so.”

Vaccinations programme makes ‘excellent progress’, says Audit Scotland report

The Covid-19 vaccination programme has made excellent progress in vaccinating a large majority of the adult population in Scotland, according to a new report published today (30 September) by Audit Scotland.

By 17 September, more than 90 per cent of people aged 18 or over had received at least one Covid-19 vaccine. Levels of vaccine wastage have been low, and the programme has helped reduce the number of people getting severely ill and dying.

However, uptake has been lower amongst young people, those in the most deprived areas and those from some ethnic minority backgrounds.

The vaccine rollout has also relied on a temporary staff drawn from across the NHS. This is an expensive model and the Scottish Government recognises that it needs a longer-term solution.

NHS boards and health and social care partnerships currently expect vaccine delivery costs to be around £223 million in 2021/22. But the final cost for this year will depend on clinical advice issued by the Joint Committee on Vaccination and Immunisation, so it could differ substantially from the current estimate.

Stephen Boyle, Auditor General for Scotland, said: “The delivery of the vaccination programme has been a success so far, with good collaboration and new digital tools developed to help the process.

“Early scenario planning by the Scottish Government and NHS boards has allowed them to continue to react quickly to formal UK clinical advice.

“There is now an opportunity for the Scottish Government to use what’s it’s learned to manage the challenges of the next part of the vaccine programme, and the wider delivery of NHS services.”

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‘The stark reality is that some council services won’t restart’

Accounts Commission: Councils and communities worked well together but impacts of Covid are unequal

Scotland’s councils reacted quickly, working alongside communities and partners to address the unprecedented challenges created by Covid-19, says a new report from the Accounts Commission. Many challenges remain significant, however, made more urgent by the multiple impacts of Covid-19 on communities and services.

Councils have a critical role in providing vital services which communities depend on. In its Local Government Overview 2021 report, the Accounts Commission, who report to the public on the performance of local government, make clear that councils, alongside their partners, quickly provided innovative and sustained support to vulnerable people.

This included supporting those who were shielding or self-isolating, switching to delivering services digitally and managing significant funding to support local businesses. 

With many council services disrupted, stopped or reduced, in particular education, social care and culture and leisure, the impact on some service users was severe and unequal. This included carers who lacked access to respite care, people with learning disabilities who were unable to access critical services and support, those receiving care at home and school children whose education was disrupted.

Covid-19 has also exacerbated and laid bare fundamental issues that need to be addressed to ensure services are maintained and that councils can tackle the multiple challenges ahead.

To help achieve this, longer-term financial certainty for councils will be vital. Whilst the Scottish Government has provided significant financial support to councils to assist in managing the net cost of Covid-19 in 2020/21, considerable amounts of funding took the form of one-off payments.

Furthermore, funding for councils beyond 2021/22 remains uncertain. Addressing this issue is vital.

Elma Murray, Interim Chair of the Accounts Commission, says: “Councils, communities and their partners have worked incredibly hard to continue to deliver vital services to local people. The stark reality is that some council services won’t restart, and some services will have to be delivered differently. 

“Underpinning this is the increasingly urgent need to address inequalities throughout Scotland’s communities. And for councils this is made more challenging because they continue to operate in a climate of significant financial uncertainty, which must now be addressed.”

Education attainment gap remains wide, says Audit Scotland

Progress on closing the poverty-related attainment gap between the most and least deprived school pupils has been limited. And more evidence is needed to understand educational achievement beyond exams.

A joint report by the Auditor General for Scotland and the Accounts Commission found that exam performance and other attainment measures at the national level have improved.

However, progress since 2013-14 has been inconsistent. And there are large variations in local authority performance, with some councils’ performance getting worse on some measures.

The poverty-related attainment gap remains wide and existing inequalities have been exacerbated by the Covid-19 pandemic. The national curriculum recognises that school is about more than exams.

And there has been an increase in the types of pathways, awards and qualifications available to young people. But better data is needed to understand if other important broad outcomes, like wellbeing and self-confidence, are improving.

The Scottish Government, councils, schools and the other bodies responsible for planning and delivering education were working well together before Covid-19.

That allowed them to respond rapidly in exceptionally difficult circumstances. Funding for education has remained largely static – rising from £4.1 billion in 2013/14 to £4.3 billion in 2018/19.

However, most of that real-terms increase was due to the Attainment Scotland Fund, which the Scottish Government set up to close the attainment gap.

Stephen Boyle, Auditor General for Scotland, said: “Significantly reducing the attainment gap is complex. But the pace of improvement has to increase as part of the Scottish Government’s Covid-19 recovery planning.

“That process needs to particularly focus on the pandemic’s impact on the most disadvantaged children and young people.”

Elma Murray, Interim Chair of the Accounts Commission, said: “There is variation in educational performance across Scotland, but this is not solely about exam performance.

“Education also supports and improves the health and wellbeing of children and young people, which has been impacted by the Covid-19 pandemic.

“It is vital that councils, schools and their partners work to reduce the wide variation in outcomes as well as understanding and tackling the short and longer-term impact of Covid-19 on learning and wellbeing.”

EIS General Secretary Larry Flanagan said: “The impact of poverty on children’s life chances remains a matter of huge concern, and much more needs to be done to support young people living in poverty to overcome the barriers that they continue to face.

“Schools do all that they can with insufficient resources to support young people from all backgrounds but cannot, in isolation, overcome such serious societal issues as inequality and poverty.”

“We have long known of the devastating impact that poverty can have on young people, and this has been made worse during the pandemic when young people from less affluent backgrounds have been far more likely to have had their in-school learning disrupted and to face barriers in accessing education outwith the school environment.”

“It is clear that much greater and sustained investment is needed to tackle the impact of poverty on young people’s education, and all of Scotland’s political parties must fully commit to tackling this issue in the context of education recovery during the next Parliament.”

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Audit Scotland: Lessons to be learned from pandemic response

The Scottish Government acted quickly to prevent the NHS from being overwhelmed by Covid-19, but it could have been better prepared to respond to the pandemic, according to a new report from Audit Scotland.

Staff across the NHS and Scottish Government took early action during the first wave in 2020, including increasing intensive care capacity and pausing non-urgent treatment. Service innovation, such as a huge rise in video consultations, also happened within weeks and it is important these are learned from.

However, there is now a substantial backlog of patients, with NHS boards prioritising those in most urgent need. It will be hard to deal with this backlog alongside the financial and operational challenges already faced by boards.

The Scottish Government based its initial response to Covid-19 on the 2011 UK flu pandemic preparedness strategy. Scotland took part in three pandemic preparedness exercises in the years before the coronavirus outbreak.

But not all the actions identified in these exercises were fully implemented.

These included measures to ensure access to enough PPE and to quickly address social care capacity, both of which became significant issues during the first wave of Covid-19.

Covid-19 has caused or contributed to the deaths of around 9,000 people in Scotland so far. People from the most deprived areas, of South Asian origin, or of Caribbean or Black ethnicity are among those who have suffered disproportionately from the pandemic. Deaths from other causes were also higher than average at the start of the pandemic.

Stephen Boyle, Auditor General for Scotland, said: NHS staff have shown extraordinary commitment to treating and caring for Scotland’s people during a pandemic that has highlighted the need to deal with long-standing health inequalities.

“Getting the full range of health services back up and running will be challenging. But there are clear lessons to be learned from the pandemic, both in how the country could have been better prepared and in the innovation that we’ve seen. It’s essential that these advances are now retained and built upon.”

Childcare expansion plans on track, says Government

The expansion of funded early learning and childcare (ELC) in Scotland is on course to be delivered from August 2020, says Children’s Minister Maree Todd – but public watchdogs have concerns over the tight timescale. 

Backed by an unprecedented £2 billion investment, by the end of the expansion more than 900 nurseries will have been built, extended or refurbished since 2018. Meanwhile, 4,310 additional full-time equivalent staff have also been recruited, resulting in a record 40,000-strong workforce.

From August, all three and four-year-olds and around a quarter of two-year-olds, will be entitled to 1,140 hours a year – almost double the current entitlement of 600 hours.

In response to Audit Scotland report on early learning expansion, Children’s Minister Maree Todd said: “We are on course to deliver the most generous, high quality early learning and childcare offer in the UK, which can transform the lives of children.

“I’ve seen and heard of the way children’s confidence and communication skills have been boosted by the care and learning they’ve received, while they’re also getting access to opportunities such as outdoor learning.

“Through our strong partnership working with local government, so much has already been achieved. There are already thousands of additional staff in post, and councils will continue to grow their teams over the coming months.

“We have also been delivering a large-scale infrastructure programme to provide high quality settings. Hundreds of nurseries have been built or refurbished, with work continuing across the country.

“We are committed to delivering the roll-out from August and councils have contingency plans in place for all critical projects due to complete this summer, so we can be confident that the places will be there to deliver the expansion for Scotland’s children. The expansion also opens up more opportunities for playgroups, private and third sector nurseries, and childminders to be involved in delivering funded hours.

“The quality of ELC provided is absolutely key. That is why we are investing in the workforce and developing improved learning opportunities for them to increase their skills and share best practice.

“With a passionate and dedicated workforce across all parts of the sector, and fantastic places for children to learn and play in a nurturing environment, there has never been a more exciting time for our childcare sector.”

However while plans to boost early learning and childcare (ELC) hours have made steady progress, risks around buildings and staffing remain, say public sector watchdogs.

The watchdog says the Scottish Government and councils are working well together to increase ELC hours from 600 to 1,140 a year from August and the pace of the expansion is broadly in line with plans.

But around half of the building work required is due to be completed over the summer, and about half of the additional ELC staff still need to be recruited. Private and third sector providers – which are expected to deliver over a quarter of the hours – also continue to report significant workforce challenges that threaten their sustainability.

The Scottish Government’s evaluation plans for the expansion are well advanced but challenges remain. For example, it is not clear how the longer-term economic benefits of the policy, or its impact on family wellbeing, will be measured.

Caroline Gardner, Auditor General for Scotland, said: “The Scottish Government and councils have worked well together to increase early learning and childcare hours, and we’ve also seen improvements in how the project will be evaluated.

“But the timeline remains tight and there are big risks around infrastructure and workforce.”

Graham Sharp, Chair of the Accounts Commission said: “Given the amount of work due to be completed over summer 2020, it’s important that councils continue to work closely with the Scottish Government to manage the risks of any delays, including how best to keep parents informed.”

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Skint! Council finances ‘unsustainable’

Most of Scotland’s 32 councils are increasingly relying on money from reserves to keep up with demand for services and balance their budgets. A report from the Accounts Commission, Scotland’s national watchdog for local government, says the financial pressures are likely to get worse. Continue reading Skint! Council finances ‘unsustainable’