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Step up pace of change now, auditor general urges NHS Scotland

Service beset by significant workforce and cost challenges; it’s not financially viable in current form

Caroline White

Friday, 26 October 2018

The NHS in Scotland has to step up its pace of change to cope with the significant workforce challenges, rising drug costs, and maintenance backlog it faces, says the auditor general in her latest audit* of the country’s health service provision.

Performance continued to decline in 2017-18 and the service is not financially sustainable in its current form, she says.

In 2017-18 the health budget was £13.1 billion, equivalent to 42 per cent of the total Scottish budget. Taking into account inflation, this was a 0.2 per cent decrease on 2016-17. NHS boards struggled to achieve unprecedented savings of £449.1 million, relying heavily on one-off savings, the report notes.

No NHS boards were able to meet all eight key national targets, and performance against these targets declined nationally. More people waited longer for outpatient and inpatient appointments. Only one of the eight key performance targets was met nationally.

The NHS is also struggling to recruit and retain the right people, and ensure they have the time and support they need, says the report. Rates of sickness absence and staff turnover have increased. Boards are also considering the potential impact of EU withdrawal on areas such as staffing, the supply and cost of drugs, and food prices.

The Scottish government wants to transform the healthcare system so that everyone can live longer, healthier lives at home or in a homely setting by 2020. Although significant activity is underway to achieve this, progress has been too slow, says the report.

The Scottish government's recent health and social care medium-term financial framework and other measures are welcome, but more needs to be done. Audit Scotland will be carrying out further work to understand how this new approach will work in practice, says the report.

"The performance of the NHS continues to decline, while demands on the service from Scotland's ageing population are growing. The solutions lie in changing how healthcare is accessed and delivered, but progress is too slow,” says Caroline Gardner, auditor general for Scotland.

"The scale of the challenges facing the NHS means that decisive action is needed now to deliver the fundamental change that will secure the future of this vital and valued service. Alongside longer-term financial planning, this must include effective leadership, and much more engagement with communities about new forms of care and the difference they make to people's lives. This will help to build support among the public and politicians for the changes required."

Theresa Fyffe, director, RCN Scotland, said that the body had highlighted for some time that the challenges of increasing costs, workforce sustainability, and growing demand are having an impact on quality of care. It has called for decisions on the future of healthcare to be made for generations to come rather than focusing on short term goals.

The auditor general’s report underlines the importance of workforce planning in delivering this, she insisted.

“Workforce planning to meet the actual demand on NHS services is vital and it is welcome to see that receive such emphasis in this year’s report.

“The message from the auditor general around recruitment and retention challenges in Scotland’s NHS underlines what those in the nursing profession have been warning about for a number of years – an unsustainable pressure on staff to deliver more care. This leads to staff burnout and, in some cases, a choice between staying in the profession and their own health.”

She continued: “With the Health and Care (Staffing) (Scotland) Bill before the Scottish parliament, MSPs can ensure that Scotland has the right number of nursing staff, with the right skills and experience, to deliver care to all those who need it. The Bill is not just an opportunity to enshrine safe staffing in law, but a chance to get the processes which support long-term workforce planning right.

“This will take investment in services and in those who deliver them. But the nursing profession is in no doubt that Scotland needs legislation on safe staffing for the wellbeing of staff and, crucially, for the safety of patients.”


*NHS in Scotland 2018. Audit Scotland, Auditor General, 25 October 2018.

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