NHS check-up reveals poor prognosis as pressures rise

Audit Scotland said all health bodies met their financial targets in 2010-11, but ten out of the 14 territorial NHS boards reported recurring deficits.

The organisation warned of growing pressures on services to come as the NHS tries to tackle persisting problems such as lower life expectancy, health inequalities, smoking, obesity and drug and alcohol misuse.

The report – Overview of the NHS in Scotland’s performance 2010-11 – said that while the overall NHS budget for 2011-12 was £232 million higher than the previous year, this was a reduction in real terms due to inflation.

It also pointed out that the NHS met three-quarters of the 28 performance targets it was due to deliver in 2010-11 – in areas such as breastfeeding and access to GP appointments – but performance varied between boards.

Health leaders warned against knee-jerk reactions to falling budgets, while the Scottish Government said it was continuing to deliver a “good deal” for the Scottish NHS.

The 46-page report said that the NHS spent £12 billion in 2010-11, and while all health bodies met their financial targets, ten reported recurring deficits. However, the overall NHS underlying deficit reduced from £39m in 2009-10 to £12m in 2010-11

Audit Scotland said there were several issues set to put even more pressure on NHS services, including rising public demand and expectations, increased costs and reducing levels of staff.

Their report said that healthy life expectancy – the amount of life spent in good health – in Scotland had increased by three years for men and over two years for women between 1999-2000 and 2007-8.

Rates of deaths from coronary heart disease, stroke and cancer have also continued to fall.

However, overall life expectancy in Scotland remains lower than that of most other western European countries and there remain significant health inequalities and long-standing health-related problems such as obesity, smoking, and drug and alcohol misuse.

Another major pressure for the NHS, the report said, was from a growing number of older people needing to be cared for. The number of people aged 65 and over in Scotland is projected to rise by around 22 per cent over ten years from 879,000 in 2010 to 1,075,000 in 2020.

Issues such as rising obesity rates – among the highest in the world – also posed challenges to the NHS, it said.

In 2010, almost two-thirds of men aged 16-64 and more than half of women in Scotland were classified as either overweight, obese or morbidly obese – ten per cent higher than in 1995.

In addition, more than 150,000 children are now classified as obese.

On staffing, the report said: “The most common approaches being taken by public bodies to reduce costs over the next few years are pay restraint and reducing workforce numbers. Many NHS bodies have already reduced staff numbers through recruitment freezes and voluntary severance schemes, with further reductions planned.

“These pressures combine with increasing public expectations of performance and quality of care and the need to tackle Scotland’s health problems.”

Between September 2009 and March 2011, NHS staff numbers were reduced by around 2,500 whole-time equivalent staff (1.8 per cent). NHS bodies have also forecast a further reduction of 2,388 staff during 2011-12.

The number of staff leaving the NHS under voluntary severance schemes has more than doubled from 157 in 2009-10 to 341 in 2010-11, with the total cost of payments in 2010-11 standing at £15.4m.

Audit Scotland said that the NHS had strategies to make the service more efficient and effective and to help improve the quality of NHS services, even as other sources of funding were dropping.

The report said that the NHS reported efficiency savings of £292m in 2010-11, representing three per cent of revenue funding. This was an increase from £202m in 2009-10.

Auditor General for Scotland Robert Black said: “At a national level, we are seeing a good picture of the performance of the NHS in Scotland.

“In 2010-11, all NHS boards met their financial targets for the third year in a row, and there is continued progress against the ‘big three’ diseases of coronary heart disease, stroke and cancer.

“However, it is clear that there are building pressures in the system from increased costs and rising expectations and demand.”

The Royal College of Nursing (RCN) warned of the consequences of reducing staff and its effects on patient care in Scotland

RCN Scotland director Theresa Fyffe said: “It’s a very honest assessment and it is clear to us that health boards cannot continue to save money by reducing the size of the NHS workforce, unless it wants to put at risk standards in patient care.”

Dr Brian Keighley, chairman of the British Medical Association in Scotland, also echoed concerns raised about building pressures in the NHS.

“We need a sensible and public debate that looks seriously at what the NHS can and cannot afford to deliver and this must be done in partnership with both those who deliver the service and taxpayers.”

Health Secretary Nicola Sturgeon said despite “swingeing Westminster-imposed cuts” to the Scottish Government’s budget, they were delivering a good deal for the NHS in Scotland.