Watchdog: Scottish NHS Reform ‘Urgently Needed’

A spending watchdog has cautioned that “difficult decisions” might be necessary concerning the ongoing provision of certain services by NHS Scotland. Audit Scotland’s review indicated an absence of a clear strategy and asserted that fundamental changes in the delivery of NHS services are “urgently needed” to address increasing demand. The health sector’s annual report revealed that, despite higher expenditure and staffing levels within the NHS, Scotland is attending to fewer patients compared to the period preceding the Covid-19 pandemic. Health Secretary Neil Gray affirmed that the government possesses a strategy designed to redirect attention towards preventative care. Speaking on BBC Radio’s Good Morning Scotland, he stated: “The plan is to shift the balance of care from the secondary services where we’re currently seeing extremely high demand in to more preventative primary care, so investing in GPs surgeries, pharmacies and optometrists to ensure people are treated earlier.” He further added: “We recognise that for too many people, they’re waiting for too long and there needs to be fundamental reform of the way our health service is delivered.” The report underscored that the Scottish government’s pledges to decrease waiting lists and times have not been met, and that delayed discharge statistics have reached their highest recorded levels. It additionally pointed out that NHS initiatives aimed at enhancing productivity and patient outcomes have not yet demonstrated an effect and are deficient in clear progress reporting. Stephen Boyle, Scotland’s auditor general, emphasized the necessity of action to address waste within the NHS, suggesting that current services should be evaluated for their effectiveness. When questioned about potential service reductions, he proposed less effective drug treatments as an area, but noted such decisions would demand difficult choices from medical professionals. He stated: “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.” He added: “Taking those steps will require greater leadership from Scottish government and NHS leaders than we’ve seen to date.” The health secretary explained that the pandemic had generated backlogs, resulting in patients presenting at hospitals with more advanced and intricate health problems. He indicated that “significant activity” was being undertaken to address this, supported by a £30m investment. Mr Gray further stated: “This will see around 12,000 additional new outpatient appointments, around 12,000 additional inpatient/day-case procedures and over 40,000 diagnostic procedures delivered.” He also noted: “This year we are providing more than £19.5bn for health and social care and under this government funding for the NHS has increased in real terms by 30%.” Health continues to be the largest single area of government expenditure in Scotland, accounting for approximately 40% of the Scottish budget. For the 2023/24 fiscal year, £19.1bn was allocated to health, representing a 2.5% real terms increase. The majority of this increase was utilized to cover pay commitments and inflation. Dr Iain Kennedy, chairman of the British Medical Association (BMA) in Scotland, commented that it was premature to consider discontinuing specific health services. He stated: “I’m seeing the calls for some services to be stopped but off the top of my head, I can’t think of anything that could be stopped.“We’re actually failing to deliver the basics at the moment so I think it’s premature to talk about stopping services. We need to be getting things right at the moment.” He further indicated that the BMA did not consider the government’s plan to be clear, remarking: “I think Neil Gray is in a difficult position.“He doesn’t have the resources that he needs for the health service and he is struggling to get the resources to the right place.” Colin Poolman, Scotland director for the Royal College of Nursing (RCN), characterized the report as “yet another damning report from Audit Scotland – the second in the space of 10 months – about the Scottish government’s stewardship of the NHS”. He further commented: “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,” Dr Sandesh Gulhane, the Scottish Conservative health spokesperson, described the report as a “damning indictment of the SNP’s appalling mismanagement” of the NHS. He stated: “Successive SNP health secretaries have been asleep at the wheel as the health service has ended up in permanent crisis on their watch.” He added: “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.” Labour health spokesperson Jackie Baillie remarked: “John Swinney likes to talk up his NHS record but this damning report shows the scale of SNP incompetence on his watch.” She continued: “Spending on agency staff is up 45% 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.” She concluded: “The report shows clearly the price hard-working NHS staff and patients are paying for the lack of leadership from the SNP.” Alex Cole-Hamilton, leader of the Scottish Liberal Democrats, asserted that the NHS “is on its knees” as a result of SNP mismanagement. He elaborated: “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,” Across the entire United Kingdom, the health service is experiencing greater pressure than at any previous time. In Scotland, the auditor general advises that the government needs to be transparent with the public regarding the financial capabilities and limitations of the NHS. A number of challenging decisions have already been implemented. Earlier this year, expenditure on new NHS buildings was suspended, which carries implications for waiting lists as construction on national treatment centres has ceased. Reductions in social care and community health budgets are creating a ripple effect in hospitals, evidenced by record numbers of patients unable to be discharged when ready, and emergency departments experiencing heightened pressure due to increased patient arrivals. Recruitment and retention efforts are being supported by substantial pay increases this year. However, staff costs already constitute 60% of the annual health budget, thereby reducing funds available for other areas. The auditor general asserts that further difficult decisions are imperative for the survival of the NHS. Implementing these will undoubtedly be neither simple nor popular, particularly for ministers who are mindful of the upcoming election. Copyright 2024 BBC. All rights reserved. The BBC is not accountable for the content of external websites. Details on our approach to external linking are available.