Executive fails to show NHS billions boost patient care

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Key points

• Executive criticised over health spending

• Audit Scotland examined expenditure of 7 billion of public money

• Auditor General concludes that "Scotland continues to suffer from some of the poorest health rates in Europe"

Key quote

"The public needs to know how well this money is used. Our report makes a start, but the health department must close the information gap. It is important that it can demonstrate that the extra money is delivering better care for patients." - Auditor General, Robert Black

Story in full THE Scottish Executive has failed to demonstrate how billions of pounds of extra investment in the NHS has benefited patient care, according to a highly critical report published today by Scotland’s financial watchdog.

In the first comprehensive report into the health service north of the Border, Audit Scotland says that ministers had to show how the 7 billion of public money pumped into health every year actually improved the standard of care and treatment.

In a major indictment of the health policy of Jack McConnell, the report also warns that a large proportion of future increases in NHS funding - set to rise to 8.7 billion by 2006 - will be eaten up on pay demands and the rising cost of drugs.

Ministers, who have resisted some of the fundamental changes introduced by the Labour government at Westminster, have argued consistently that extra money invested in the Scottish NHS is making a real and tangible difference to the lives of Scots.

But the report by Robert Black, the Auditor General, will be used by critics to support growing statistical evidence which suggests the extra money being spent every year on the health service is not improving performance.

The Scottish health budget has grown from 6 billion three years ago to more than 8 billion this year, a rise of 33 per cent. But the number of people on the waiting list has lengthened and the average waiting time for both outpatients and inpatients has also risen over the same period.

Mr Black called on ministers to do more to demonstrate that increased funding and new ways of working were improving standards of care.

"The public needs to know how well this money is used," he said. "Our report makes a start, but the health department must close the information gap.

"It is important that it can demonstrate that the extra money is delivering better care for patients."

Mr Black said the Executive’s health department expected NHS boards to deliver improved services for patients through the implementation of new pay agreements, but "it has not fully specified the outcomes it expects to see".

He added: "It must identify and measure what improvements it expects ... as a result of this investment."

Mr Black concluded that Scotland continues to suffer from some of the poorest health rates in Europe. He stressed that while some improvements were being made and key targets were being met, Scotland still had high death rates in areas such as cancer, heart disease and strokes, when compared with other EU countries.

The auditors found there was little explanation on how targets were being met, and Tom McCabe, the deputy health minister, agreed that the NHS must provide more information.

He said: "We have made it clear to the NHS Information and Statistics Division that they must further improve coverage and quality of management information, particularly in the areas of outpatients, primary and community care and care provided by nurses and allied health professionals." However, the most worrying political aspect of the report for the First Minister is that it highlights the growing divide between the way the health service is run north and south of the Border.

Tony Blair is determined to reform the NHS in England, using the private sector where necessary, giving patients more choice and tailoring individual services to the needs of local communities.

However, in Scotland, Mr McConnell has taken a different approach, typified by his refusal to embrace foundation hospitals and privately run specialist clinics, which feature strongly in Mr Blair’s plans.

As a result, waiting lists are falling fast in England, where the new target for a hospital operation will be 18 weeks, whereas waiting times are 40 per cent up in Scotland, where the maximum hospital wait is one year and three months.

Last night, the British Medical Association launched a fierce attack on Scotland’s poor health record and called for a review of how services are delivered.

Dr Bill O’Neill, the organisation’s Scottish secretary, said: "It is shameful in this day and age that deprivation and inequalities ensure that we remain the sick man of Europe, despite increased spending on health and investment in the NHS workforce.

"We would welcome detailed plans of long-term investment in measures to protect and improve public health, such as legislating for smoke-free public places, improving access to healthy food and reducing consumption of alcohol, particularly among young Scots." And he added: "There is an urgent need for better workforce planning for doctors and other health professionals.

"Any plans must go hand in hand with a review of how we deliver services, particularly in the most remote and rural communities in Scotland."

Political opponents used the report to call for more robust targets and a widespread reform of the health service.

David Davidson, the Conservative Party health spokesman, acknowledged that investment had been "poured into the NHS", but said waiting lists continued to rise.

He said: "One of the major reasons why Scotland’s waiting lists and waiting times have become a national scandal in recent years is precisely because the service, under this government, is not patient-centred, but instead is controlled, directed and dictated by ministers."

Mr Davidson also said that a rise in administration and running costs in the NHS, caused by "a centralised and nationalised NHS responding to ministerial targets rather than clinical care".

"We need radical reform that puts patients first, gives them real choice and frees the NHS from the dead hand of government," he said.

Stewart Stevenson, the SNP’s deputy health spokesman, said: "While it may be reassuring to hear that an increasing amount of money is being spent on the NHS in Scotland, what we are still unsure of is how this will truly benefit patients."

Mr Stevenson added: "The health minister must now make it clear about how money is being spent, so that conclusions can be drawn about whether the Executive is doing what is best for Scottish patients and indeed NHS staff."