Neil Gray faces 'significant fall in hospital productivity' in new role as health secretary

The scale of the challenge facing newly appointed health secretary Neil Gray has been revealed in a new report that shows the Scottish NHS is now treating fewer patients than it was before the pandemic despite an increase in funding and staff.

Gray, who was wellbeing economy secretary, was handed responsibility for the health portfolio yesterday following the resignation of incumbent Michael Matheson, who is being investigated by the Scottish Parliament Corporate Body (SPCB) after last year becoming embroiled in a scandal over the use of a parliamentary iPad.

Having resisted calls to resign when the scandal unfolded, Matheson said he was standing down now because he did not want the SPCB’s imminent report into his handling of the affair to be a “distraction” from the work of government.

It comes as independent economic research institute the IFS publishes a report that details how there has been “a significant fall in hospital productivity” in Scotland in the years since the pandemic, with delayed discharge and the reduction in the number of hospital beds contributing to a drop in the number of patients being treated. That is despite staff numbers and spending increasing.

According to the report, the Scottish NHS handled 21 per cent fewer elective inpatient admissions between April and June last year – the most recent period for which data is available – than in the three months between October and December 2019.

There were also eight per cent fewer emergency admissions, nine per cent fewer elective day patients and eight per cent fewer outpatient appointments.

At the same time, health spending per person increased by 10 per cent in real terms between the two periods, with NHS Scotland employing nine per cent more consultants and six per cent more nurses in the spring of last year compared to the winter of 2019.

The report’s author, IFS research economist Max Warner, said that while the fall in productivity is in line with what has happened elsewhere in the UK, it is more marked in Scotland because funding and staffing have grown at a slower rate.

He added that unless productivity can be significantly boosted NHS Scotland will struggle to get back to pre-pandemic performance levels.

“The Scottish NHS is still feeling the effects of the Covid-19 pandemic. Despite higher funding and more staff than in 2019, hospital activity remains substantially below pre-pandemic levels,” he said.

“The fall in measured hospital productivity is similar to what we have documented for England, but the reduction in activity is larger in Scotland because funding and staffing have grown by less than in England.

“Many potential factors are likely contributing to hospitals treating fewer patients despite having more staff.

“These include a reduction in the number of available hospital beds, patients requiring more care in hospital because they are sicker than pre-pandemic, the continued presence of Covid-19 patients in hospital, and difficulties discharging patients from hospitals.

“Without a substantial boost to hospital productivity, there is a risk that even additional funding and staffing will not bring the Scottish NHS back to pre-pandemic performance.”

Figures from Public Health Scotland paint a mixed picture of performance across the NHS. Data published this month show that there were 1,813 people well enough to go home but waiting to be discharged at the end of December 2023, representing a drop of five per cent on the previous month.

Similarly, the number of people having planned operations cancelled at the last minute fell, from 2,369 in December 2022 to 2,014 in December 2023.

Overall, the service had increased the number of people it expected to bring in for a planned procedure, with the total rising from 20,429 at the end of 2022 to 20,837, but activity remained lower than pre-pandemic levels, with 25,791 booked in for an operation in December 2019.

During yesterday’s session of FMQs First Minister Humza Yousaf faced a grilling from Labour leader Anas Sarwar over the number of people who died last year while waiting for an ambulance to take them to hospital.

Yousaf said he did not have the numbers to hand but that his government had “brought forward a recovery plan that is helping the NHS” and is “putting additional resources into the ambulance service”.

In response, Sarwar said waiting lists had gone up since the recovery plan was published, with “over 800,000 of our fellow Scots [on] an NHS waiting list while he dithers around looking for a decent stat”.

He added that 12,000 people had died after calling an ambulance last year, saying “that is up from just over 7,100 in 2019, an increase of over 70 per cent in just four years”.

“Many of these people may have survived if an ambulance could have reached them sooner, or they could have been admitted to hospital more quickly,” he said.

Responding to the IFS report Labour health spokesperson Jackie Baillie said it “lays bare the SNP’s woeful failure to deliver the NHS recovery Scotland desperately needs”.

“With waiting lists at a record high and almost one in six Scots still waiting for appointments and treatment there is an urgent need to ramp up activity, but hospitals simply cannot cope,” she said.

“Services are at breaking point, staff are exhausted and demoralised, and patients are being put at risk, but while our NHS was buckling under pressure, the SNP has been distracted by its own scandal and sleaze.

“With Michael Matheson finally gone, the next health secretary must step up to the job and deal with the crisis in our NHS by tackling delayed discharge, supporting staff and delivering a real catch-up plan.”

The Scottish Conservatives, meanwhile, will today pledge to deliver 1,000 more GPs and guarantee that every Scot will be able to get an appointment with a family doctor within a week of calling should they win power at the next Holyrood election.

Party leader Douglas Ross said: “The most common way that people interact with our health service is through GP appointments, yet the share of the budget allocated to GP services has declined.

“And the result has been that, since 2012, 86 local medical facilities have been shut down in favour of increased centralisation.

“As a bare minimum people expect to be able to see a GP in a manner convenient to them. That is why we would increase the portion of NHS funding given to GP services.

 “This would enable us to recruit 1,000 more GPs; introduce a ban on local health closures, while reopening practices to ensure there are no blank spots across the country; make appointments as accessible as possible by offering online booking and consultations; and introduce a new national standard of one week for waits for a GP appointment.

“This would make unacceptable waits just to see your GP a thing of the past.”