NHS Scotland still failing to meet demand, warns Audit Scotland
Fundamentals of NHS reform need to be addressed, while health boards need to have longer term financial planning, warns Audit Scotland
Hospital bed - Mark Hillary
Scotland's public spending watchdog Audit Scotland has warned improvements to Scotland's NHS have stalled as it struggles to meet demand.
Despite record spending on the NHS, increasing demand has meant growing pressure on budgets and longer waiting times, the latest annual report said.
It is the third annual report by Audit Scotland to have issued a similar warning.
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The body hailed progress in integrating health and social care, developing better data, and embedding a 'realistic medicine' approach.
Staff remain committed and patient satisfaction is high, it said, but increasing costs, workforce sustainability and growing demand is having an impact on the quality of care.
"It's still not clear how moving care into the community will be funded, and what future funding levels will be required," it said.
"A clear and long-term framework is needed that features how funding will be used differently to change services, alongside greater financial flexibility for NHS boards."
While health boards are restricted by one-year budgets and made to make 'efficiency savings', “Scotland’s health is not improving and significant inequalities remain.”
A longer term approach to financial planning is needed across the health service, Audit Scotland recommended, while improvements must be made to governance, accountability and transparency.
Meanwhile, "the majority of key national performance targets were not met in 2016-17".
Health Secretary Shona Robison said there was no "quick fix" to the pressures on the health service, but she faced opposition calls for her to quit over the report.
Caroline Gardner, Auditor General for Scotland, said: "The NHS in Scotland marks its 70th anniversary next year, and there is widespread agreement that healthcare must be delivered differently if it is to withstand growing pressure on services.
"There is no simple solution, but these fundamental areas must be addressed if reform is to deliver the scale of transformation that's needed across the NHS. Involving staff, the public and bodies across the public sector will also be crucial for success."
Chair of doctor's union BMA Scotland Dr Peter Bennie said: “This latest report makes clear that it is getting harder and harder for the NHS in Scotland to cope with continued austerity. Demands on the NHS are increasing rapidly every year and sufficient resources are simply not being made available to meet the needs of patients.
“The report also raises serious questions about how the aim of moving more care into community settings will be funded and achieved against a backdrop of continuing financial pressures."
Royal College of Nursing (RCN) Scotland Associate Director Norman Provan said: “The RCN Scotland has been warning of the increasing pressures on the NHS and Integration Authorities for some years now and it is clear from the Auditor General’s report that significant change to the way we work is still required in order to meet the increasing demand on services and to maintain the quality of care.
“We need clarity on how the Health and Social Care Delivery Plan, moving towards delivering more care in our communities, will be funded and implemented and on how staff and the public will be engaged in developing the options for services in the future."
Dr Miles Mack, Chair of RCGP Scotland, said it was "frustrating" that the same warnings had to be made every year.
“As Audit Scotland explains, we cannot deliver the step change the system requires without shifting spending away from hospitals," he said.
"Underfunding general practice is the root cause of so many of the issues the NHS now faces. We are pleased that a professional consensus is coalescing around that fact."
Robison said: “We have long been realistic about the challenges for the NHS and the need for change.
"Alongside record investment of over £13 billion, including almost half a billion pounds of NHS spending being invested in social care services alone, we are looking at new ways of delivering services that meet the changing needs of people across Scotland."
Scottish Labour Health spokesperson Anas Sarwar said it was time for Robison to to be removed as health secretary.
““A year ago Audit Scotland published the worst state of the NHS report since devolution. Twelve months on and standards have either stalled or declined," he said.
“Seven out of eight key performance indicators are still being missed, with declining standards for cancer treatment and patients waiting for appointments.”
Scottish Conservative shadow health secretary Miles Briggs said: “What more indication could the SNP need to show it has to change its ways on the NHS.
“For years it neglected the health brief at the expense of agitating for separation, and now those chickens are coming home to roost."
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