Change 'urgently needed' to safeguard the future of the NHS, Audit Scotland warns

A fundamental change in how NHS services are provided is “urgently needed”, ministers have been told.

Audit Scotland warned that “difficult decisions” may need to be made about whether some services can continue to be provided.

The Scottish Government doesn’t have a clear plan explaining to the public how it will reform the NHS and address the pressures on services, the public spending watchdog said.

The new report made clear that without change being made “the NHS is unlikely to be able to meet growing demand”.

Its latest report highlighted the increasing pressures facing Scotland’s health service, including rising costs and the pausing of investment in new facilities.

With the report also highlighting “growing demand” for NHS services, Audit Scotland found: “Scotland’s NHS is still struggling to deliver care in a timely way, most waiting times standards are not being met.”

First Minister John Swinney insisted that “progress” is being made in “improving the performance of the National Health Service in the light of the significant increases in demand in the aftermath of Covid”.

But Auditor General for Scotland Stephen Boyle insisted: “To safeguard the NHS, a fundamental change in how services are provided remains urgent.”

He added: “The Scottish Government needs to set out clearly to the public and the health service how it will deliver reform, including how progress will be measured and monitored.

“Difficult decisions are needed about making services more efficient or, potentially, withdrawing those services with more limited clinical value to allow funding to be redirected.

“Taking those steps will require greater leadership from Scottish Government and NHS leaders than we’ve seen to date.”

His comments came as the report found that “despite increasing funding and staffing, the NHS in Scotland is still seeing fewer patients than before the Covid-19 pandemic”.

And it added that “progress to reduce the backlog of care has been slower than anticipated”.

The report was released after research by the Institute for Fiscal Studies (IFS) last week found that the NHS recovery in Scotland after the pandemic has been slower than in England.

Now Audit Scotland has said there needs to be “increased and ongoing focus on improving the health of Scotland’s people to reduce the pressure on the NHS”.

The report from the public spending watchdog warned: “Without this change, the NHS is unlikely to be able to meet growing demand.”

However, it went on to state that the Scottish Government’s vision for health and social care “is not clear on how current operational issues will be addressed or how reform will be prioritised”.

Here it added: “Difficult decisions will need to be made about transforming services and, potentially, what the NHS stops doing.

“This requires both Scottish Government and NHS leaders to show greater leadership.”

Overall the report was clear that “to address current financial pressures, fundamental change in how NHS services are provided is now urgently needed”.

It added: “The need for reform is more urgent than ever. Its scale and pace must increase if pressing capacity and affordability issues are to be addressed.”

Audit Scotland said the government “now need to focus more on longer-term reform, including difficult decisions about what the NHS should potentially stop doing”.

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

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

He insisted: “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.”

Speaking for the Scottish Government Swinney, however, said: “We are making progress in improving the performance of the National Health Service in the light of the significant increases in demand in the aftermath of Covid.”

The First Minister added: “There are more procedures being undertaken within the National Health Service, which is an indication that we are making inroads into the challenges we face.”

He went on to state: “The government has a very clear plan about concentrating on reducing delayed discharge, tackling the waiting times issues that we face and making sure we have investments in people and infrastructure that will secure the future of the National Health Service.

“That’s the foundation of the plans that the government is bringing forward to deliver progress in the National Health Service and to meet the needs of people in Scotland.”

But Scottish Conservative health spokesperson Dr Sandesh Gulhane said the report was a “damning indictment of the SNP’s appalling mismanagement of Scotland’s NHS”.

The Tory said: “Successive SNP health secretaries have been asleep at the wheel as the health service has ended up in permanent crisis on their watch.

“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.”

Dr Gulhane added: “In the week of the Budget, this report should be an urgent wake-up call for the SNP to ensure that money is invested in the right areas of our NHS, to ease the burden on patients and staff suffering due to their incompetence.”

Labour health spokesperson Jackie Baillie was also critical of the Scottish Government, saying: “John Swinney likes to talk up his NHS record but this damning report shows the scale of SNP incompetence on his watch.

“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 added: “The report shows clearly the price hard-working NHS staff and patients are paying for the lack of leadership from the SNP.”

Health secretary Neil Gray agreed that “reform is essential” for the NHS, adding: “We know people are waiting too long for treatment but remain determined to reduce waiting times.

“Significant activity is under way through our £30m investment to target pandemic backlogs. 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 continued: “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%.

“But we are determined to continue to improve our NHS and the Budget we set out tomorrow will throw the weight of the government behind performance improvements and ensure we can tackle the challenges in our health service.”