NHS Scotland 'not sustainable' and performance ‘in decline’, warns Audit Scotland

NHS Scotland’s performance in meeting key targets is in a downward spiral because its current model is not financially sustainable, the country’s spending watchdog has warned.

Audit Scotland’s annual assessment of the health services finances said no health board had met all of the key national targets and all were “struggling to break even”.

Demand on the health service continues to rise, with mounting pressure from staffing levels and rising drug costs, which have increased by 19 per cent in five years.

The "declining performance against national standards indicates the stress NHS boards are under," it said.

The report advised: “The scale of the challenges means decisive action is required, with an urgent focus on the elements critical to ensuring the NHS is fit to meet people’s needs in the future.”

The Scottish Government spent £13.1bn on the NHS in 2017/18 – 42 per cent of the total Scottish budget. However, Audit Scotland warned that taking into account inflation, this was a 0.2 per cent decrease from 2016/17.

The auditor has issued similar warnings for a number of years, but the last year saw “significantly more” emergency loan funding for health boards, who made “unprecedented” savings.

Health Secretary Jeane Freeman recently announced these loans would be written off, and boards will move from one-year to three-year accounting.

But Audit Scotland also warned Brexit will pose “additional challenges” for the NHS.

Auditor General Caroline Gardner 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."

Freeman welcomed the recommendations and said the Scottish Government was “already taking these forward”.

She said: "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.”

The Scottish Parliament’s Public Audit and Post-Legislative Scrutiny Committee has pledged to investigate further.

Convener Jenny Marra said: “This report is a clear warning from the Auditor General that NHS Scotland is not financially sustainable.

“Our Committee will be looking very closely at this critical report and its recommendations so that Parliament can get to grips with the reform that our NHS needs for the future.”

Chair of BMA Scotland, Dr Lewis Morrison said: “One warning is repeated over and over again in Audit Scotland’s latest report: That the NHS is not in a financially sustainable position.

“This stark warning could not be any blunter, but will come as no surprise to frontline doctors who have faced the consequences of inadequate funding year after year.

“As the BMA and others have warned for some considerable time, funding in the NHS is simply not keeping pace with demand and that has pushed NHS services across the country into the parlous position this report details.”

Scottish Conservative shadow health secretary Miles Briggs said the SNP “has no one to blame but itself”, while Labour’s Monica Lennon said government had routinely ignored the problems raised by staff and the people who rely on the NHS”.

Alison Johnstone MSP, the Scottish Greens’ health spokesperson, said: “Politicians from all parties would do well to heed to the words of the auditor general who says that tackling the NHS’s financial and performance issues must begin by ‘changing how healthcare is accessed and delivered’.”