Leader comment: No future in a health service we can't afford

The Scottish Government states that our health budget is at its highest ever level, but today's Audit Scotland report renders that statistic relatively meaningless.

NHS Scotland faces "major challenges" says an Audit Scotland report. Picture: Greg Macvean

Only one out of eight key standards receives pass marks in the report, which highlights a series of shortfalls in budgets that have seen health boards resort to loans, one-off payments and a cut in the use of private sector support to try to make the books balance.

Health trusts will not meet their budget targets, and two authorities alone are set to record a combined over-run of £140 million.

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So although the NHS Scotland budget increased by 2.7 per cent over the past year, the costs of provision has far outstripped that resource.

What we have to admit here is that we cannot afford the health service that we try to provide. As a model for future provision in the NHS, this position is unsustainable.

It is no surprise that costs have increased significantly. Advancements in medical science have contributed to an improvement in life expectancy, but that comes at a cost, as care for the elderly takes its toll on resources. Care at home is a more cost effective way of looking after the elderly than residential 24-hour care, but it is not free of charge. It has to be properly funded if it is to be effective, and its budget has to track the anticipated steady increase in requirement for this service.

None of this is breaking news. But the present situation over NHS funding suggests that although we are aware of the issues faced, we are in denial that reform is required if an adequate health service is to be maintained.

Once we acknowledge that the current strategy no longer works, we have to decide if we want to provide fewer services through the NHS, or increase its budget.

If we go with the former, we then have to decide what we want to keep publicly funded, and what parts have to fall to the private sector. If it is the latter, we have to decide if paying for the NHS will be at the expense of another part of public sector funding – and with education also in need, that’s a challenge – or raise taxation to pay for the greater good.

These are the kind of “brave decisions” which the Royal College of Nursing has spoken of. But we are nowhere near coming to any such conclusion. It’s not that heads are in the sand; instead, they are ducked below the parapet. Our politicians know the NHS is struggling, but very few are willing to get involved in an honest debate that needs to discuss the options available, however unattractive they might look. There is too much concern that this kind of political debate will backfire at the ballot box.

And yet without addressing these seemingly unpalatable options, NHS Scotland’s record will only deteriorate further. The debate we need to be having is not taking place, and unless it does, there is no hope of progress.

The agenda has to move on from the political soundbites of “protecting” the NHS, to talking about how to reform it. At present, the future is only a picture of further failure, on the balance sheet and in our hospitals.