Scotland’s NHS “not financially sustainable”, says public audit watchdog

Her annual review of the NHS, Caroline Gardner reports that performance continued to decline in 2017/18 as pressure is building in several areas, including major workforce challenges, rising drug costs and a significant maintenance backlog.

In 2017/18 the health budget was £13.1 billion – 42 per cent of the total Scottish budget. Taking into account inflation, this was a 0.2 per cent decrease from 2016/17. NHSboards struggled to achieve unprecedented savings of £449.1 million, relying heavily on one-off savings.

No NHS boards were able to meet all eight key national targets and performance against these targets declined nationally. More people waited longer for outpatient and inpatient appointments. Only one of the eight key performance targets was met nationally.

The Auditor General also said the NHS faces significant workforce challenges, with difficulties recruiting and increases in sickness absence and staff turnover. There is evidence that the NHS is struggling to recruit and retain the right people, and ensure they have the time and support they need. Boards are also considering the potential impact of EU withdrawal on areas such as staffing, the supply and cost of drugs, and food prices.

The Scottish Government wants to transform the healthcare system so that everyone can live longer, healthier lives at home or in a homely setting by 2020 and reacting to the report’s findings, Health Secretary Jeane Freeman said the government was already taking forward Audit Scotland’s recommendations.

But while acknowledging that significant activity is underway to work towards this, the Ms Gardner said progress is too slow.

“The Scottish Government’s recent health and social care medium-term financial framework and other measures are welcome steps”, Audit Scotland said. “But more needs to be done. Audit Scotland will be carrying out further work to understand how this new approach will work in practice.”

Caroline Gardner, Auditor General for Scotland, said: “The performance of the NHS continues to decline, while demands on the service from Scotland’s ageing population are growing. The solutions lie in changing how healthcare is accessed and delivered, but progress is too slow.

“The scale of the challenges facing the NHS means that decisive action is needed now to deliver the fundamental change that will secure the future of this vital and valued service. Alongside longer term financial planning, this must include effective leadership, and much more engagement with communities about new forms of care and the difference they make to people’s lives. This will help to build support among the public and politicians for the changes required.”

Health Secretary Jeane Freeman said the government was already taking forward Audit Scotland’s recommendations.

She said NHS funding had reached “record levels of more than £13bn this year, supporting substantial increases in frontline NHS staffing, as well as increases in patient satisfaction, reductions in mortality rates, falls in healthcare associated infections, and Scotland’s A&E performance has been the best across the UK for more than three years.”

She added: “While our NHS faces challenges, common with health systems across the world, we are implementing a new waiting times improvement plan to direct £850m of investment over the next three years to deliver substantial and sustainable improvements to performance, and significantly improve the experience of patients waiting to be seen or treated.

“Ultimately we want to ensure people can continue to look forward to a healthier future with access to a health and social care system that continues to deliver the world-class compassionate care Scotland is known for.”