‘Urgent need’ for Scottish NHS reform – Watchdog

A spending watchdog has warned that “difficult decisions” may need to be made about whether some services can continue to be provided by the NHS in Scotland.

A review by Audit Scotland said there was an “urgent need” for fundamental change in the way NHS services were delivered because without change “the NHS is unlikely to meet increasing demand”.

Scotland is seeing fewer patients than before the Covid-19 pandemic – despite rising costs and staffing in the NHS – the health sector’s annual report has found.

First Minister John Sweeney said progress was being made to improve the performance of Scotland’s health service despite a “significant increase in demand”.

The report highlighted that Scottish Government promises to reduce waiting lists and times have been missed and late discharge figures are the highest on record.

It added that NHS initiatives to improve productivity and patient outcomes had yet to have an impact and there was a lack of clear progress reporting.

Scotland’s Auditor-General Stephen Boyle said the government needed to “set out clearly” how it would deliver reforms.

He said: “To protect the NHS, a fundamental change in the way services are delivered is essential.

“Difficult decisions are needed about how to make services more efficient or, potentially, re-direct funding to withdraw those services with more limited clinical value.

“Taking these steps forward will require more leadership from Scottish Government and NHS leaders than we have seen to date.”

Speaking during a visit to Forth Valley Hospital on Monday, the First Minister said “progress” was being made.

He said: “The Government has a very clear plan to reduce delayed discharges, tackle waiting time issues and ensure we invest in the people and infrastructure that support national health. Secure the future of the service.

“It is the basis of the plans the Government is bringing forward to improve the National Health Service and meet the needs of people in Scotland.”

Audit Scotland said the government needed to “focus more on long-term reforms, including difficult decisions about what the NHS should potentially stop doing”.

These “difficult choices” will need to consider “what level and type of services can be provided in the future”.

Health is the single largest area of ​​government spending in Scotland, accounting for around 40% of the Scottish budget.

In 2023/24, £19.1bn was allocated to health – an increase of 2.5% in real terms. Most of the increase was used to cover salary commitments and inflation.

Colin Poolman, Scottish director of the Royal College of Nursing (RCN), said it was “yet another damning report from Audit Scotland – the second in the space of 10 months – about the Scottish Government’s responsibility for the NHS. About”.

“Without a sustainable, long-term solution to the chronic shortage of nursing staff, the Scottish Government will struggle to achieve the reforms it needs,” he added.

Scottish Conservative health spokesman Dr Sandish Gulhane said the report was “a damning indictment of the SNP’s appalling mismanagement” of the NHS.

He said: “Successive SNP health secretaries have been asleep at the wheel as the health service has fallen into permanent crisis on their watch.

“Their tight workforce planning and complete lack of vision means delayed discharges have reached record levels, millions of Scots are on NHS waiting lists and cancer waiting times are longer than a decade. are not fulfilled.”

Labour’s health spokeswoman Jackie Bailey said: “John Sweeney likes to talk up his NHS record but this damning report shows the scale of the SNP’s incompetence on his watch.

“Spending on agency staff has increased by 45% compared to five years ago, yet delayed discharges are at record highs and three quarters of NHS waiting list targets are missing – 17 years after the SNP, our The health service is broken.”

He added: “The report clearly shows that hardworking NHS staff and patients are paying the price for the SNP’s lack of leadership.”

The leader of the Scottish Liberal Democrats, Alex Cole Hamilton, said the NHS was “on its knees” because of the SNP’s mismanagement.

“Millions of Scots are stuck on NHS waiting lists, while record numbers are stuck in hospital because they cannot 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 NHS recovery plan has failed,” he said.

Health Secretary Neil Gray agreed that “reform is essential” for the NHS, and said ministers knew people were waiting too long for treatment.

Significant activity continues through our £30m investment to target pandemics. This will provide approximately 12,000 additional new outpatient appointments, approximately 12,000 additional inpatient/day case procedures and more than 40,000 diagnostic procedures.

“This year we are delivering more than £19.5bn to health and social care and funding for the NHS has increased by 30% in real terms under this government,” he said.

The health service across the UK is under more pressure than ever.

Here in Scotland, the Auditor General says the government needs to be clear with people about what the NHS can and cannot do.

Some tough decisions have already been made.

Earlier this year, spending on new NHS buildings was halted – which will have an impact on waiting lists as work on national treatment centers grinds to a halt.

Budget cuts to social care and community health are having an impact on hospitals where record numbers of patients are not being sent home when they are ready and emergency departments are feeling the pressure as more patients arrive.

This year the focus is on recruitment and retention with significant salary increases. But staff costs already account for 60% of annual health spending, meaning less money to spend elsewhere.

The auditor general says more difficult decisions must come if the NHS is to survive. Making them will never be easy or popular, especially for ministers with one eye on the next election.