Complex NHS structure ‘limiting’ drive for reform, auditors warn

The complexity of the healthcare system in Scotland is limiting the ability to drive reform in the NHS, the public sector watchdog has said.

Audit Scotland has called for NHS governance to be strengthened in its latest report, warning there are “weaknesses” in scrutiny.

In particular, auditors say lines of accountability and decision-making are “difficult” due to the mix of local, regional and national partners.

The report also says there are risks at Scottish Government level, including that the director-general for health and the chief executive of NHS Scotland is a combined role.

“This results in dual responsibility for setting the strategic and operational direction of NHS Scotland and holding the NHS to account for its performance,” it warns.

Auditors have made eight broad recommendations to ministers on improving governance within the NHS, including providing clarity through a framework refresh and strengthening the role of non-executive directors.

Stephen Boyle, the auditor general for Scotland, said: “The delivery of NHS services must be reformed for Scotland’s health service to remain affordable and sustainable. 

“NHS Scotland’s governance arrangements are key to delivering that reform, but they need to be strengthened. The planning of healthcare in Scotland is becoming more complex and the Scottish Government needs to ensure lines of accountability and decision-making are clear.”

Ministers have pledged to deliver broad public sector reform, including of the health service, to deliver better value for money and reflect the needs of an ageing population.

But Audit Scotland has previously warned that the government lacked a clear plan for delivering that reform.

First Minister John Swinney launched the NHS “renewal framework” in January, which included a commitment to grow capacity in the system and increase the proportion of funding going towards primary and community care.

Health Secretary Neil Gray said the report supports the approach already being taken by the Scottish Government, which would work with boards to ensure delivery.

He added: “The recently published operational improvement plan - that focuses on the four key areas of improving access to treatment; shifting the balance of care; digital and technological innovation; and prevention - along with the forthcoming publication of a population health framework and a health and social care service renewal framework in June, establishes a clear path.”

The Scottish Conservatives said the report proved the SNP had created a barrier to necessary reforms. Health spokesman Sandesh Gulhane said: “The report makes clear the SNP are an obstacle to the change that’s so desperately needed to make our health service more effective.

“That includes too much money being wasted on bureaucracy, which should be spent on the frontline.”

And Scottish Labour’s deputy leader Jackie Baillie said: “The SNP’s overcrowded and bureaucratic structures are standing in the way of modernisation and hindering accountability.”

Both opposition parties have committed a major restructuring of health boards if they win next year’s election.

The Scottish Government has been contacted for comment.