NHS needs to take greater care on financial housekeeping

Published on Tuesday 29 June 2010 14:51

THOUSANDS of new staff recruited to the NHS in Scotland but no commensurate rise in the number of procedures and operations; regular and sustained increase in spending on the NHS in Scotland but a growing reliance on locum doctors by hospitals with fears of patient care being put at risk: who, or what, is in charge of the NHS?

And are its affairs being managed as efficiently and effectively as we would wish?

Searching questions are now being asked because of the decision to exempt spending on health from the financial rigours now being imposed on other public services. Indeed, it is because of this exemption that some departments are now facing ferocious spending cuts of up to one third over the next few years.

Spending on the NHS in the UK has exploded tenfold in real terms from 12 billion in 1950 to 120 billion today. In Scotland it has now risen to more than 10 billion annually. But insulating the NHS from the budget reductions being faced elsewhere does not mean it has a carte blanche to spend as it pleases, or that vote-pleasing commitments entered into before the financial crisis struck - such as free prescription charges - should be regarded as sacrosanct.

Earlier this month the Edinburgh-based International Futures Forum gave a stark warning that current levels of spending on health in Scotland were "not sustainable". Indeed, the paper, by Dr. Margaret Hannah, a consultant in Public Health Medicine, warns that the Scottish NHS could face making more cutbacks than its counterpart in England.

Then, earlier this week, the Scottish Parliament's health and sport committee expressed itself mystified as to how 10,000 extra staff funded by the SNP administration has failed to result in a significant rise in procedures. While the health minister recently announced plans to shed almost 4,000 posts the committee found there was little evidence that the extra workers should have been employed in the first place.

Now comes a scorching attack by Professor Chris Isles, based at Dumfries and Galloway Royal Infirmary, on the calibre and quality of locums being sent to hospitals, largely as a result of the European Working Time Directive. A recent report by Audit Scotland found that the NHS in Scotland spent 47 million on locum doctors in 2008-09, some 43 per cent of overall medical staffing expenditure. About 27m of this was on agency locums.

Separate from this, but closely related in financial terms, is the relentless increase in the cost of "free" personal care for the elderly - more additional spending on a "flagship" policy whose financial implications were barely grasped at the outset.

No-one wishes to see services cut, or the quality of care out in jeopardy. But the NHS must improve efficiency where it can, streamline services, eliminate duplication and put a firm cap on the pay and bonuses of bureaucrats at the top. Protection from cuts does not mean exemption from tight financial housekeeping.