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NHS Scotland ‘running too hot’ and needs ‘large-scale change’: Audit Scotland

Auditor General for Scotland Caroline Gardner. Image credit: John Need

NHS Scotland ‘running too hot’ and needs ‘large-scale change’: Audit Scotland

Audit Scotland has found Scottish NHS board deficit will increase to £207m, and the Scottish Government’s pace of change to address a £1.8bn predicted shortfall in health board funding “has been too slow”.

On Thursday, the spending watchdog released its annual report of NHS Scotland and said the results called for the Scottish Government to “refocus its priorities to speed up health and social care integration and system wide reform”.

Audit Scotland found the deficit at Scotland’s 14 health boards would rise to £207m, and there had been a rise in the number of health boards requiring additional financial support.

“The size of the predicted deficit also increased for 2018/19, from £99 million to £150 million, but decreased to £116 million for 2019/20. For 2021/22, however, the deficit is predicted to be significantly larger, at £207 million,” the report said.

“Most of this deficit relates to NHS Lothian, which predicts a deficit of almost £90 million, and NHS Greater Glasgow and Clyde, which predicts a deficit of £61.5 million.”

The report found the healthcare system faced “increasing pressure from rising demand and costs, and it has difficulty meeting key waiting times standards”. It stated that achieving “financial sustainability remains a major challenge for NHS boards”.

“Without reform, the Scottish Government predicts that there could be a £1.8 billion shortfall in the projected funding for health and social care of £18.8 billion by 2023/24. So far, the pace of change to address this, particularly through the integration of health and social care, has been too slow.

“Capital funding from the Scottish Government has decreased by 63 per cent over the last decade and the level of backlog maintenance remains high, at £914 million. High-profile, newly-built hospitals have come under significant scrutiny because of health and safety concerns.”

Audit Scotland recommended: “These boards needed to make additional savings to offset any predicted overspend against their budget. There is a risk that boards will be unable to break even and will require additional financial support from the Scottish Government.”

The report made a long list of recommendations, including that NHS boards and the Scottish Government improve “the quality and availability of data and information, particularly in primary and community care”, and that the government finalise and publish “as a matter of urgency” its capital investment strategy, develop a “single annual staff survey” relating to behaviours, culture and staff experience in NHS Scotland, and publicly report progress against the health and social care delivery plan.

Auditor General for Scotland Caroline Gardner said: “The NHS in Scotland is running too hot, with intense pressure on staff and a service model that will remain financially unsustainable without a much greater focus on health and social care integration.

"We're beginning to see examples of new ways of delivering healthcare but they're some distance from the system-wide reform the NHS needs,” she said. “The challenge for the Scottish Government and its partners will be to agree new priorities that enable large-scale change and which create a leadership culture that supports and respects all staff.”

On hospitals, the report described the issues at Queens Elizabeth University Hospital and Ediburgh sick kids hospital as having come under “considerable scrutiny as a result of significant health and safety concerns”, and said it was “essential” that the Scottish Government and health boards “learn from these projects when planning new healthcare facilities”.

“Delays in opening a new healthcare facility can mean that an older site must be operational for longer than expected. This can result in additional expenditure to make sure that the older site remains fit for purpose for longer. In these circumstances, the relevant NHS board and the Scottish Government should provide assurance that any risks to patient and staff safety have been addressed.”

Audit Scotland also said the Scottish Government’s ambitions for a 2020 vision “will not be achieved by 2020”, and the government should “set out priorities that support large-scale, system-wide reform to increase the pace of change”.

“Collaborative leadership is needed to focus on better partnership working, staff engagement and promoting positive workplace behaviours,” the report said. “Staff are at the heart of the NHS and it is vital that more is done to support them so that they can care for people in a safe, fulfilling and respectful environment.”

Cabinet Health Secretary Jeane Freeman said she “welcomes” Audit Scotland's findings, which “recognises the challenges our NHS faces, such as increasing demand, building a sustainable workforce and the pace of change”.

“Work to ensure people get access to health and social care services is also progressing, but it needs to happen faster. Our delayed discharge figures show areas where integration is making a difference and we continue to work closely with COSLA to accelerate progress and make this happen across the country,” Freeman said.

Meanwhile, Public Audit and Post-Legislative Scrutiny Committee convener Jenny Marra, a Scottish Labour MSP, said the committee would “be prioritising our scrutiny of this report to understand more fully how the Scottish Government and health boards plan to tackle the £200m plus deficit predicted for 2021/22”.

“Last year’s report from the Auditor General said NHS Scotland’s position was not financially sustainable, and now we see the NHS deficit spiralling," Marra said.

Scottish Labour health spokesperson Monica Lennon said the report was “damning” and showed “health and social care services are on the brink of financial disaster”. “It is embarrassing that the government is not on track to meet its 2020 vision for the NHS and is struggling to meet key performance targets. The facts show that bringing in Jeane Freeman as Health Secretary has made little difference,” Lennon said.

Scottish Conservative shadow health secretary Miles Briggs said the report made for “desperate reading”, from the “ongoing hospital building scandals, to the failure to deliver the integration of health and social care services”. “This is another utterly damning reporting by independent Audit Scotland into SNP minsters and their shocking mismanagement of our NHS,” Briggs said.

Scottish Greens health spokesperson Alison Johnstone called for Freeman to respond to her motion calling on the Scottish Government to undertake “an urgent review of GP recruitment, resources and funding”. “It’s clear from the Audit Scotland report that if we are to provide the support that patients and dedicated NHS staff deserve then such a review must be undertaken and acted upon immediately,” she said.

Last year's report Audit Scotland annual assessment found no health board had met all of the key national targets and all were “struggling to break even”, while demand on the health service continues to rise.

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