Additional health policy ambitions and uncertainty around future covid-19 spending has left Scotland’s health boards under mounting financial pressure, says Scotland’s financial watchdog.

Six of Scotland’s health boards - NHS Ayrshire & Arran, NHS Borders, NHS Dumfries and Galloway, NHS Fife, NHS Highland and NHS Orkney - are singled out as being in such dire financial straits the Scottish government is having to provide them with additional support.

Though the pandemic has placed ‘unprecedented pressures’ on the NHS, which will remain on emergency footing until at least March, Audit Scotland says the service was not financially sustainable before 2020.

In its assessment of the NHS published today, the public sector watchdog said last year health boards received 19% more to spend, but a £16.3bn total allocation was not enough to prevent several needing extra from central funds to balance the books.

The independent national audit organisation also believes initiatives to both reform delivery and plan ahead – both of which are needed to allow the NHS to recover from the pandemic – are being hampered by little data and too many policy initiatives.

Covid-19 restricted boards’ ability to make efficiency savings says Audit Scotland - but future savings of more than £100m will still need to be achieved which, the watchdog says, will only add to ‘substantial financial pressures which existed in the NHS before the pandemic’.

The report reveals a new Care and Wellbeing Portfolio, which will oversee financial, service and workforce planning as well capital investment across health and care, is currently being developed by the Scottish government.

The auditors say it has ‘promising potential’ to help the NHS become more sustainable, but the new group is still in its early days and more detail is needed on how it will achieve its ‘challenging’ goals in integrated and preventative care.

The Scottish government has welcomed the Audit Scotland report saying it recognises the severe pressure the NHS was put under by the pandemic and the investment in supporting staff and recruiting additional people to work in the service.

Stephen Boyle, Auditor General for Scotland, said learning from pandemic-induced changes in health service delivery will help the government achieve its recovery goals.

"Reforming the NHS is key to the Scottish government's pandemic recovery plan and needs to remain a priority. Putting covid costs to one side, health spending is rising every year, meaning less money for other public services.

"There's now a clear opportunity to do things differently by building on the innovation and collaboration we've seen across the NHS in the last few years.”

Health Secretary Humza Yousaf welcomed the report’s focus on staff and supporting the NHS recovery:

“Staffing levels across NHS Scotland have reached a record high after an increase of over 7,600 whole time equivalent staff in the last year, and we are committing £1bn in our NHS Scotland Recovery Plan to get more patients seen as quickly as possible and tackle the backlogs of care.

“The report shows we worked quickly to support staff wellbeing – introducing a range of measures backed by £12m investment, in addition to funding the recruitment of additional staff across a variety of health and care services.

“We agree with Audit Scotland that there is a clear opportunity to do things differently and build on the innovation and collaboration shown during the pandemic. That is why our work, including steps to improve data collection, and commitment to invest 20% more – £2.5bn – in our NHS will support recovery and reform; delivering a more sustainable health and social care system that reduces inequalities and promotes good health.” 

The SNP in its 2021 manifesto promised to rethink the structure of the NHS by the end of this parliament, but attempting this, at the same time as the ongoing social care review, would be “a hell of an onion to bite into” according to an expert in public service reform.

Mr Boyle added that “better-informed policy decisions and services won’t be possible without better collection and use of data”, as the report lamented that a lack of quality data has been highlighted by auditors as a key area of improvement repeatedly over several years.

A growing number of competing policy initiatives– including increasing inpatient and day case activity to 20% above pre-covid levels, an overhaul of care pathways and the development of a National Care Service - also risks progress, according to the auditors.

Staff wellbeing must not be sacrificed in order to meet challenging targets the report says, as it outlines the ‘significant extra demands’ the Scottish government’s plans will place on workers. 

Dr Lewis Morrison, chair of the doctors’ trade union BMA Scotland, said Audit Scotland’s findings back his organisation’s calls for people to temper their expectations about “what the NHS can deliver within its current limitations”.

“The report is absolutely right to focus in on staffing, and the clear danger that a lack of proper workforce planning, based on reliable data, will undermine any possible NHS recovery.

“It also rightly highlights the danger that driving exhausted staff to meet unattainable and unrealistic targets risks making things worse – with individual wellbeing suffering, and the obvious conclusion being that this will simply push more people out of the NHS altogether at this crucial time.”

Early intervention and prevention as well as workforce wellbeing, Audit Scotland says, should be the priority of the service going forward.

Holyrood’s opposition parties responded to today’s report with concerns over workforce and poor planning.

Scottish Labour’s health spokesperson, Jackie Baillie MSP, said today’s report is “just about the most damning Audit Scotland report in the NHS since devolution” and that the government has failed to support the NHS properly for years:

“Only robust planning will do to get our NHS back on track, but Humza Yousaf’s eyes are not on the ball.” 

Dr Sandesh Gulhane MSP, Scottish Conservative health spokesperson, said the “damning report” shows Scotland’s NHS in in crisis and that the SNP’s “flimsy covid recovery plan will not solve it”:

“The report highlights the recruitment problem across the NHS - and that’s a product of poor workforce planning by the SNP Government.”

For the Scottish Green Party, Gillian Mackay MSP agreed supporting existing staff alongside recruitment will be ‘key’ to recovery:

"It’s vital that workforce planning reflects the new reality, to make sure services have the staff they need to care for generations to come."

 

Read more: Kerley: Run major hosptials from Edinburgh; Budget: Major increase in social care spending; Government denies move to take GPs out of NHS;

 

 

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