It's about the money - Audit Scotland and the NHS

Opposition parties understandably jumped the on the latest Audit Scotland report on the NHS in Scotland, which said spending had become so tight in health boards many may struggle to break even.

It isn't the first time the country's spending watchdog has warned services are not being redesigned at a pace to match government ambitions while demand is far outstripping budget.

At FMQs Nicola Sturgeon was quick to point out the opening paragraph of Audit Scotland's report pointed to rising life expectancy, quality and patient safety. NHS Chief Exec Paul Gray tweeted me to say it was hardly 'grim'.

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NHS boards 'struggling to break even'

The Auditor General's 'but' in that message is nevertheless a pretty hefty one, and repeats messages made every time she reports on the health service, individual health boards and the progress of integration. 

Health and Sport Committee convener Neil Findlay this week preempted the report when he asked civil servants to explain how, if spending was going up in real terms, health boards were having to slash budgets.

"Are any cuts being made to services?" he asked Deputy Director for Health Finance Christine McLaughlin, repeatedly. 

"I will say that boards are taking an approach that involves identifying savings to their baseline that do not impact on clinical outcomes," she replied. "What the convener says is not language that I would typically use with boards nor is it language that directors of finance would use."

But the reality is that to shift spending from the acute sector into community settings, something has to give. Either that, or the levels of increase in health funding will need to be far higher than any party is willing to make. 

Meanwhile, the government line about how the Scottish health system compares to the NHS in England is becoming less and less relevant as the two models drift further and further apart. It cannot remain a useful comparator when the two systems are so very different in their approaches to tackling the same problems, especially when no-one at Holyrood is advocating an England-style approach north of the border.