Urgent action needed to tackle mounting pressure on the NHS, Audit Scotland report finds

The NHS “urgently needs to move away from short-term fire-fighting to long-term fundamental change”, according to Audit Scotland

SCOTLAND’S PUBLIC spending watchdog, Audit Scotland, has found mounting pressures on the NHS which require a faster pace of reform if a pattern of declining performance is to be halted.

The report published today [25 October] found that the health service is “not financially sustainable in its current form” with the health boards struggling to make savings of almost £450m in 2017/18.  Forty-two per cent of the Scottish Government’s annual budget is now spent on the NHS.

The auditor general’s annual report on the health service found that the NHS is under intense pressure in several areas including workforce challenges, rising drug costs (up 19.4 per cent over five years) and a significant maintenance backlog.

Only one of eight national performance targets were met and performance against these targets has declined in every health board, resulting in more people having to wait longer for outpatient and inpatient appointments.  

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 health care 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."

Between 2016/17 and 2017/18 the Scottish Government has increased the health budget by 1.5 per cent to just over £13bn (a 0.2 per cent real terms fall).

Restricted budgets has intensified staffing issues, with difficulties in recruiting and increases in sickness absence. The number of unfilled vacancies has increasedfor 2017/18 in areas such as consultants, GPs and nursing. Sixty per cent of consultant vacancies have been open at least six months, 30 per cent of nursing and midwifery vacancies open at least three months, and it took more than six months for GP vacancies to be filled in 2017/18.

The number of NHS staff who have been on sick leave has increased from 5.2 per cent in 2016/17 to 5.4 per cent in 2017/18.

Dr Lewis Morrison, Chair of BMA Scotland said: “Medical vacancies are adding significantly to the difficulties we face and not enough is being done to attract or retain doctors working in Scotland. The report is clear that workforce planning is still inadequate and the Scottish Government need to tackle this urgently. There simply must be concerted action taken to address recruitment and retention issues for doctors, and indeed all staff, to ensure that working in Scotland’s NHS is an attractive career choice.

“The [Audit Scotland] report also makes it apparent that the action needed has to be much more than simply a numbers game, focussed on a narrow range of politically driven waiting time’s targets for access to acute care. We need to adopt a more mature, wide-ranging way to asses our NHS and the care it delivers, that trusts much more in the clinical judgement of medics.”

Children and Adolescent Mental Health Services (CAMHS) patients saw the most significant decline in performance with 70 per cent of those patients being seen within 18 weeks.

Key recommendations of the report include developing a robust and transparent financial management system, identify why NHS leadership posts are difficult to fill, develop a capital investment strategy to ensure the capital budget is used efficiently and put staff, communities and the public at the centre of implementing changes to the service. 

READ MORE: What does the Scottish Health Survey tell us about how healthy Scotland is?

The overall message of the report was that the NHS “urgently needs to move away from short-term fire-fighting to long-term fundamental change.”

Health Secretary Jeane Freeman welcomed Audit Scotland report, saying that the Scottish Government is already taking forward the recommendations.

Freeman said: "Under this Government, NHS funding has reached record levels of more than £13 billion 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.

"While our NHS faces challenges, common with health systems across the world, we are implementing a new waiting times improvement plan to direct £850 million 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.

READ MORE: Scottish Government offer biggest pay rise for NHS staff since 2008 recession

"Our investment in shifting the balance of care from hospitals and specialist services to the community means more people are receiving care in the right place and the right time and able to live independently for longer.”

Scottish Labour Shadow Cabinet Secretary for Health and Sport, Monica Lennon MSP, said the Audit Scotland report exposed “SNP mismanagement”

Lennon stated: “This damning report confirms the devastating consequences of SNP mismanagement of our NHS.

“Nicola Sturgeon’s government has routinely ignored the problems raised by staff and the people who rely on the NHS. Her inaction has put the future of our NHS under threat, with the financial and workforce problems worsening under her watch.”

Picture courtesy of WorldSkills UK

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