Scotland's NHS financially unsustainable and under severe pressure, Audit Scotland says

Scotland’s NHS is under severe pressure and efforts to address substantial backlogs may be hindered by factors including plans for a National Care Service, the Auditor General has said.

A review of the NHS by Audit Scotland warned the health service was not financially sustainable before the pandemic and the scale of the challenge had now been “exacerbated”.

It pointed to an “ever-increasing backlog of patients waiting to be seen”.

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Critics said the “scathing report” was a “damning indictment on almost a decade and a half of SNP mismanagement”.

The spending watchdog said the Scottish Government had ambitious plans to redesign NHS services, but stressed they “will be challenging and take a long time to realise”.

Its report said: "The ambitions in the plan will be stretching and difficult to deliver against the competing demands of the pandemic and an increasing number of other policy initiatives, such as plans for developing a National Care Service.”

It said the NHS had struggled to “recruit enough people with the right skills” and increasing staffing must be a priority.

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Stephen Boyle, Auditor General for Scotland, said: "Reforming the NHS is key to the Scottish Government's pandemic recovery plan and needs to remain a priority. Putting Covid costs to one side, health spending is rising every year, meaning less money for other public services.

"There's now a clear opportunity to do things differently by building on the innovation and collaboration we've seen across the NHS in the last few years.

"For that to happen, our leaders must take the public with them and involve them in the shift from care being delivered in hospitals to much closer to people's homes.

"But better-informed policy decisions and services won't be possible without better collection and use of data."

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The report said the health service in Scotland was on an emergency footing and remains under severe pressure.

Audit Scotland found an additional £2.9 billion of funding was allocated in 2020/21 across health and social care, including £1.7bn for health boards.

In 2020/21, the health budget was £18bn, accounting for 35 per cent of the total Scottish Budget.

Of this, the NHS funding allocation was £16.3bn, an increase of 19 per cent in cash terms on the £13.7bn the previous year.

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The report said: “The NHS was not financially sustainable before the Covid-19 pandemic, with boards relying on additional financial support from Government or non-recurring savings to break even.

“The scale of the financial challenge has been exacerbated by the pandemic.

“The cost of delivering services has risen and additional spending commitments made by the Scottish Government add to NHS boards’ financial pressures.”

A total of 14 of the 22 NHS boards required additional Scottish Government funding to achieve financial balance in 2020/21, with six boards facing a “particularly challenging financial position”.

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These were NHS Ayrshire and Arran, NHS Borders, NHS Dumfries and Galloway, NHS Fife, NHS Highland and NHS Orkney.

Scottish Labour health spokeswoman Jackie Baillie said: “This scathing report is a damning indictment on almost a decade and a half of SNP mismanagement of our NHS and care sectors.

“This is just about the most damning Audit Scotland report in the NHS since devolution.

“The report is explicitly clear – the SNP Government has entirely failed to support the NHS properly for years and as a result the whole system is under exceptional pressure.

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“The failure of [health secretary] Humza Yousaf’s so-called NHS recovery plan is plain for all to see as one in eight Scots languish on waiting lists, staff are exhausted and the NHS remains on emergency footing.

“Only robust planning will do to get our NHS back on track, but Humza Yousaf’s eyes are not on the ball.

“Scottish Labour has repeatedly called on the SNP to back our proposals for an NHS catch-up plan to reduce waiting times and a rise to care workers pay to £15 an hour.

“It is clear only Scottish Labour has the plan and the ambition to get our NHS back on track and to deliver a National Care Service worthy of the name.”

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Scottish Conservative health spokesman Dr Sandesh Gulhane said: “This damning report confirms what we have been saying for some time – that Scotland’s NHS is in crisis on the SNP’s watch and that Humza Yousaf’s flimsy Covid recovery plan will not solve it.

“The report highlights the recruitment problem across the NHS – and that’s a product of poor workforce planning by the SNP Government.

"There are huge vacancies across the health service yet we can’t fill them because we don’t have enough trained people to do so.

“That’s why the Scottish Conservatives have called for the cap to be removed on the number of places at Scottish universities for healthcare-related courses.

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“As we emerge from the pandemic, the ever-growing backlog in patients awaiting treatment is a ticking timebomb, but again we see no strategy from the health secretary for getting on top of this.

“The report also calls on the Scottish Government and health boards to work with the social care sector to tackle the problem of delayed discharge, yet the SNP vowed to eradicate this years ago and have failed miserably to do so.

“Scotland’s NHS is on an emergency footing, but I have no confidence that the SNP and Humza Yousaf are capable of restoring it to full health given their dire track record.”

Scottish Liberal Democrat leader Alex Cole-Hamilton warned the NHS and its staff “are on the verge of burnout”.

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He said: “They have been let down by 15 years’ worth of botched workforce and pandemic planning by the SNP Government, which gave them no option but to work flat out.

“There is still no realistic plan to deal with the old problems made worse, from delayed discharges to record staff vacancies and waiting lists lasting years. It is putting lives at risk.

“This report shows why the SNP/Green Government was wrong to vote down our plans for a burnout prevention strategy to protect staff.

"It must also now back Scottish Liberal Democrat proposals for a Health and Social Care Staff Assembly that puts their expertise and experience at the very heart of the crisis response.

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“At this rate, the NHS recovery plan will need upgraded to a resuscitation plan. Patients and staff desperately need new hope and deserve better than ministers who seem determined to turn their attentions towards independence.”

Professor Andrew Elder, president of the Royal College of Physicians of Edinburgh, said: “This report highlights the significant financial impact of the pandemic on our health and care services.

“It points out that workforce planning is vital if we are to clear backlogs and get onto a level footing in our NHS.

“The college believes that quality care should be available for every person who requires it.”

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Mr Yousaf said: “The pandemic has put our NHS under the most severe pressure in its 73-year existence, and we welcome Audit Scotland’s acknowledgment that health and social care staff have shown extraordinary commitment.

“Staffing levels across NHS Scotland have reached a record high after an increase of over 7,600 whole-time equivalent staff in the last year, and we are committing £1bn in our NHS Scotland Recovery Plan to get more patients seen as quickly as possible and tackle the backlogs of care.”

The health secretary added: “We agree with Audit Scotland that there is a clear opportunity to do things differently and build on the innovation and collaboration shown during the pandemic. That is why our work, including steps to improve data collection, and commitment to invest 20 per cent more – £2.5bn – in our NHS will support recovery and reform.”

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