No clear plan for NHS reform, says Audit Scotland

There is no clear plan for NHS reform in Scotland, a new report by Audit Scotland has found.  

The auditor general has said the Scottish Government needs a delivery plan that clearly sets out to the public how it will reform the health service and address the existing pressures.  

The independent auditor described the Scottish Government’s vision for health and social care as "not clear” on how operational pressures on the NHS will be addressed or how reform will be prioritised. 

It said it must work with NHS staff, partners and the public to set out a clear delivery plan and make difficult decisions about how it may reform or potentially end some services. 

Audit Scotland said that commitments to reducing waiting lists have not been met, while the number of people remaining in hospital because their discharge has been delayed is the highest on record. 

The report has also concluded that NHS initiatives to improve productivity and patient outcomes have yet to have an impact and lack clear progress reporting.   

Health accounts for around 40 per cent of the Scottish Budget, and although the NHS in Scotland has benefited from increased staffing and funding it is still seeing fewer patients than before the pandemic.  

Most of the extra funding has been spent on covering pay commitments and inflation, while costs are forecast to continue to rise.  

Stephen Boyle, Auditor General for Scotland, said: “To safeguard the NHS, a fundamental change in how services are provided remains urgent. The Scottish Government needs to set out clearly to the public and the health service how it will deliver reform, including how progress will be measured and monitored.   

“Difficult decisions are needed about making services more efficient or, potentially, withdrawing those services with more limited clinical value to allow funding to be re-directed. Taking those steps will require greater leadership from Scottish Government and NHS leaders than we’ve seen to date.” 

Scottish Conservative shadow cabinet secretary for health Sandesh Gulhane said: “This report is a damning indictment of the SNP’s appalling mismanagement of Scotland’s NHS. 

“Successive SNP health secretaries have been asleep at the wheel as the health service has ended up in permanent crisis on their watch. 

“Their dire workforce planning and complete lack of vision means that delayed discharge has reached record levels, hundreds of thousands of Scots are on NHS waiting lists and cancer waiting times have not been met for over a decade. 

“Combined with Humza Yousaf’s flimsy Covid recovery plan and Neil Gray’s disastrous proposals for this winter, it is clear the SNP are out of ideas when it comes to fixing the crisis in our NHS.” 

He added: “In the week of the Budget, this report should be an urgent wake-up call for the SNP to ensure that money is invested in the right areas of our NHS, to ease the burden on patients and staff suffering due to their incompetence.” 

Scottish Labour's health spokesperson Jackie Baillie said: "John Swinney likes to talk up his NHS record but this damning report shows the scale of SNP incompetence on his watch. 

"Spending on agency staff is up 45 per cent on five years ago yet delayed discharge is at a record high and the NHS is missing three-quarters of waiting list targets — after 17 years of the SNP, our health service is broken. 

"The report shows clearly the price hard-working NHS staff and patients are paying for the lack of leadership from the SNP. 

"The UK Labour government delivered a record budget settlement for Scotland for our NHS and other public services but Scotland needs an end to SNP bungling and a change of direction under Scottish Labour." 

Scottish Liberal Democrat leader Alex Cole-Hamilton MSP said: “Under the SNP’s mismanagement, our NHS is on its knees. 

“Hundreds of thousands of Scots are trapped on an NHS waiting list, while record numbers are stuck in hospital because they can’t get the care they need at home or in the community. 

“With staff overwhelmed and the health and social care system going backwards on so many measures, the SNP Government must now admit that its three-year old NHS Recovery Plan has flopped. It needs rewritten to get people seen quickly and fix care so that patients can leave hospital on time.” 

Colin Poolman, Royal College of Nursing Scotland director, said: “This is yet another damning report from Audit Scotland – the second in the space of 10 months – about the Scottish government’s stewardship of the NHS. 

“Like us – we have consistently called for a retention strategy for nursing staff – Audit Scotland continues to call for clear strategies and plans for NHS reform and how the Scottish government plans to address the extreme pressures on staff and services. 

“Audit Scotland highlights missed commitments to reduce waiting lists and times, increases in delayed discharges and the lack of impact to date of initiatives to improve productivity and patient outcomes. 

“The Auditor General rightly lauds staff for their contribution. The report states that the workforce is the NHS’s ‘most important asset’ and that in the face of severe and increasing pressures ‘a committed workforce has continued to work to deliver high-quality care’. 

“But the Auditor General’s report also echoes our concerns about the workforce crisis. The report states: ‘The demands of a growing and ageing population on top of these pressures, as well as the ongoing backlog created by the pandemic, mean the current healthcare delivery model is not sustainable.’ 

“Without a sustainable, long-term solution to what is now a chronic shortage of nursing staff the Scottish government will struggle to achieve the reform required.” 

Yesterday, the first minister svowed to make health services improvements a top priority. 

John Swinney said: “Scotland has had the best-performing core Accident & Emergency Units in the UK for nine years, we have more GPs per head than anywhere else in the UK and we have prevented the disruption of strike action by settling fair pay deals for frontline NHS workers.

“But we know that health services everywhere face huge pressure in light of the Covid-19 pandemic – and ours is no exception.

“When I became first minister, I made clear that one of my top priorities was improving public services like the NHS. Since then, I have thrown the weight of the Scottish Government behind tackling some of the key challenges it faces – whether that is increasing capacity in hospitals or making it easier for people to see a GP.

“Our budget this week will be a budget which has improving the NHS at its heart. We have listened carefully to suggestions from patients and staff – as well as engaging constructively with organisations and political parties across the parliament. 

“I want to make progress on improving our NHS, but to do that, parliament must approve our Budget Bill in order to unlock investment which will drive the long-term and lasting improvements – and the healthier population - that we all want to see.”