‘Concern’ as Scottish NHS bodies rack up multimillion pound PR and consultancy bills

Questions over spending by health organisations facing major deficits

The network of public bodies across Scotland’s financially beleaguered NHS is spending nearly £14 million a year on external consultants, sparking criticism at a time when many organisations are seeking to make cost savings in order to deal with spiralling deficits.

The Scotsman’s ongoing investigative series into the financial stewardship of the nation’s quangos can reveal that the annual external consultancy bill for Scotland’s 14 regional health boards alone stands at more than £7.6m, drawing criticism from unions at a time when grave concerns remain around NHS budgets.

The spending records, disclosed under the Public Services Reform (Scotland) Act, show that across Scotland’s 24 public health bodies, more than £13.8m was spent on external consultants in 2022/23. However, the overall spend is likely to be even higher, given several bodies could not provide any figures, despite being legally bound to do so, or submitted incomplete information.

NHS National Services Scotland, a non-departmental public body tasked with helping health boards to save money and free up resources so that they can be reinvested into essential services, spent £4,600,000 on outside consultants. NHS Greater Glasgow and Clyde, the largest health board in Scotland, spent £2,649,733. The majority of that figure - some £1,790,015 - went on “revenue consultancy.” In February, Unison Scotland entered a formal dispute with the health board of a series of job cuts.

The external consultancy bill at NHS Highland, which has identified more than £84m of “cost improvements and reductions” in 2024/25, was £1,752,320. Healthcare Improvement Scotland spent £578,000, while NHS Forth Valley’s bill was £509,477. During the period in question, the Scottish Government took formal oversight of Forth Valley’s work in order to address issues surrounding unscheduled care and out-of-hours services.

Scotland’s NHS bodies also spent heavily on public relations, with the total bill standing at nearly £6.3m for the 12 month period, although several bodies failed to provide figures. NHS Lothian, which needs to close a £133m budget gap, spent the most of any health organisation, with a total expenditure of £944,000, up sharply from the £797,000 bill in 2021/22.

NHS Lanarkshire, a board facing a £112m funding black hole, spent £660,000, while NHS Highland ran up a £537,623 bill. NHS Fife, another board facing financial pressures, spent £531,234. NHS 24, which has been criticised for caller waiting times, ran up a public relations bill of £838,536.

NHS Lothian spent the most of any health organisation on public relations. Picture: Shutterstock

The total overseas travel for the 24 bodies exceeded £1m, with NHS Greater Glasgow and Clyde (£261,687); NHS Grampian (£232,508); NHS Education for Scotland (£189,876); NHS Lothian (£187,000); and NHS Ayrshire and Arran (£72,049) the highest spenders. Over £647,000 was spent across the NHS on hospitality and entertainment, with NHS Lothian spending the most, at £167,000.

Matt McLaughlin, Unison Scotland’s lead organiser for health, said: “At a time when health boards are freely admitting that they are around five per cent underfunded, Unison members and the general public will find some of these figures very concerning, particularly when their services are under constant review; waiting lists continue to rise and patient complaint are on the rise.

“Of course Unison appreciates that there is a need for some of this spend. For example public relations departments respond to media enquiries and ensure that there is strong and effective messaging over public health issues such as Covid. But we would question whether the time and money spent defending leadership decisions is reasonable.

“Similarly with overseas travel, whilst we are sure that much of that cost will be legitimate, it will no doubt concern the public that health boards continue to spend in this area at a time when patients are being cared for in hospital corridors – the public and Unison members need to be assured that this spend is necessary, proportionate and adds value to our local NHS services.

The scrutiny of health spending forms part of The Scotsman's week-long investigative series into Scotland's quangos.

“In respect of external consultants, we do need to recognise that the overall spend in Scotland is significantly less than other parts of the UK health service – however that does not excuse what appears to be an increasing spend on external consultants who are simply concerned with making a profit and stripping money from our NHS.”

Dr Iain Kennedy, chair of BMA Scotland’s council, said: “We know NHS Scotland is massively under-resourced, with demand outstripping capacity, an ongoing workforce crisis and patients facing unacceptably long waiting times.

“Health boards have limited budgets and we would hope are focused on spending what funding they do have wisely, and in particular on supporting hard pressed doctors and other healthcare workers to do the very best they can for patients.”

Two health bodies could not provide The Scotsman with any details of their 2022/23 spending, as required by the legislation. NHS Golden Jubilee, a national health board, apologised for not having the information due to an “administrative oversight” it is working to rectify. The Scottish Ambulance Service said it was compiling the data and aimed to publish it as soon as possible. NHS Shetland, meanwhile, could only provide its external consultancy spend. Its website has no details of annual expenditure for previous years. Public Health Scotland did not provide The Scotsman with details of its public relations spend at the time of press.

A Scottish Government spokeswoman said: “We’re investing more than £19.5 billion in health and social care services, with NHS staffing levels at a record high. Effective communication to help people understand policies and access public services, or to prompt behaviour change and promote better health, is a key part of NHS boards’ work.

“NHS boards make decisions on their spending, including the use of external consultants and overseas travel, where this is necessary to provide the most effective services. This information is published to ensure transparency and discussions are held on a regular basis with each NHS board on how it is utilising its resources to ensure value for money.”