Fundamental changes needed if NHS is to survive, says Audit Scotland

Fundamental changes to the NHS will be needed if the institution is to survive as a high quality public service, according to a new report by Scotland’s budget watchdog.

A new report by Audit Scotland, NHS in Scotland 2015, has found that tightening budgets, rising costs, higher demand for services, demanding targets and standards, and increasing staff vacancies mean the health service will need to change quickly to survive.

The report warns: “The Scottish Government has not made sufficient progress towards achieving its 2020 vision of changing the balance of care to more homely and community-based settings.”

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NHS boards reported £275m in total savings in 2014/15.

The Scottish Government said the report showed it had increased frontline spending on the NHS, while Scottish Labour described it as “damning”, accusing the SNP of taking “a sticking plaster approach which kicks problems into the long grass”.

The report put health board spending at £11.4 bn in 2014/15, with a £10m underspend.

Audit Scotland warns that every area board has struggled to meet national performance targets within budget, and many have been required to make one-off savings or take extra financial support from the Scottish Government to break even.

In March 2015 only two of nine key waiting time targets and standards were met – reflecting a general decline in performance in recent years.

Auditor General for Scotland Caroline Gardner warned the NHS, “will not be able to provide services as it does at present due to the number of pressures it faces within the current challenging financial environment.”

She said: “We have highlighted concerns around targets and staffing in previous reports. These have intensified over the past year as has the urgency for fundamental changes such as introducing new ways to deliver healthcare and developing a national approach to workforce planning.

“It is important that the Scottish Government and health boards work closely together to help alleviate these pressures and also increase the pace of change necessary to meet its longer-term ambitions.”

Around 140,000 people work in the NHS in Scotland – the highest number of staff in its history.

The report highlights that recruiting and retaining permanent staff is a significant problem for boards, leading to more being spent on temporary staff.

It says: “this approach is increasingly expensive and provides only a short-term solution. In 2014/15, NHS boards spent £284 million on temporary staff, an increase of 15 per cent from 2013/14.”

The Scottish Government said the report showed it had increased the frontline, resource spending on the NHS.

Health Secretary Shona Robison said: “Scotland’s NHS is now performing better against tougher targets, and as Audit Scotland highlights, we have a record high workforce and the level and quality of care provided to patients has contributed to people living longer along with continued advances in diagnosis, treatment and care.

“In addition we have delivered historically low waiting times, large reductions in hospital infection rates, and some of the highest quality and safest healthcare anywhere in the world.

“We have met and indeed exceeded our commitment to protect funding for front-line health services, with the total health budget growing to over £12 billion for the first time and resource spending growing by 5.8 per cent in real terms in the five years to 2015-16.”

Robison said she agreed change would need to happen faster to meet the Government’s 2020 vision to provide more care in the community.

She said: “Earlier this year we unveiled our £60 million primary care fund which will be invested over the next three years to address immediate workload and recruitment issues, as well as putting in place long-term, sustainable change. We are also working on a completely new GP contract to be in place by 2017 which will implement much of the learning from the next few years to redesign these services in a collaborative way.

“Since this report was written we have also announced a further investment of £200 million to create six new elective treatment centres which will allow people to be treated more quickly and help health boards meet increasing demand for a growing elderly population.”

Scottish Labour pointed to figures showing the health budget has decreased by 0.7 per cent in real terms between 2008/09 and 2014/15.

Meanwhile it highlighted figures showing the cost of private agency staff has increased by 53 per cent, while the use of private doctors to cover shifts increased by 22 per cent.

Scottish Labour Public Services Spokesperson Jackie Baillie said: “Nicola Sturgeon wants people to judge her on her record, but this damning expert report shows that the SNP Government in Edinburgh has cut the NHS budget, and patients and staff have suffered as a result.

“Those problems are now becoming apparent, and they are very serious. For our NHS to be suffering across such a broad ranges of issues, affecting so many health boards, shows that these are not isolated incidents but a fundamental problem with how the SNP have managed our NHS.

“For years the SNP have protested that they were protecting the health budget – today’s expert report shows that the health budget decreased on their watch.

“The SNP Government has presided over a target driven culture in our NHS and then failed to resource our health service properly so that seven out of nine of these targets have seen a performance that just isn’t good enough.

“We are seeing an increased use of private staff to cover shifts and vacancies for A&E staff lying unfilled for six months: under the SNP NHS staff are undervalued, under resourced and under intolerable pressure. This sticking plaster approach cannot continue. It's time for the SNP Government to get a grip and deliver an NHS fit for the future.”

Alison Johnstone, Scottish Green MSP for Lothian, said: “Scottish Greens have consistently prioritised preventative spending - investing in good health now so we ease the pressure on the service downstream. We will continue to press this case in the forthcoming Scottish budget.

“It's alarming that the auditors say that despite recommendations made last year, ministers have yet to introduce indicators to measure progress towards preventative and community-based care.

“It's also a concern that although record numbers of people are employed in the NHS in Scotland, they are undoubtedly over-stretched. 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 the changing health of Scotland's population.”

Scottish Conservative health spokesman Jackson Carlaw said: “The Scottish Conservatives have been calling on changes to be made to our healthcare for months. We know about the pressures of the NHS in Scotland under the SNP government.

“Things are tough now and the service will deteriorate in the future if these problems are not dealt with now.

“The SNP response to a problem is a superficial announcement and a few short term measures - anything to escape a bad headline or substantive resolution of the actual problem.

“Patients deserve far better and the NHS needs far more support, which is why Scottish Conservatives have promised an additional 1000 nurses, not 1000 empty SNP words.”