NHS ministers have been warned they may be forced to withdraw some NHS services to prioritise other parts of the NHS for funding.

Scotland’s spending watchdog has warned some NHS services may need to be “withdrawn” by SNP ministers to allow funding to be shifted to other areas of the health service amid “difficult decisions” in the budget.

The warning by Audit Scotland comes ahead of SNP finance secretary Shona Robison unveiling her draft budget on Wednesday.

SNP health secretary Neil Gray | Jeff J Mitchell/Getty Images

Ahead of the spending blueprint being published, First Minister John Swinney has stressed that reviving the NHS will be his government’s priority.

Although SNP ministers will receive an extra £1.7 billion earmarked for the NHS next year as part of a £3.4bn boost from the Labour UK government, concerns have been raised that pay deals and already-existing pressures could leave the Scottish Government with little else to allocate in their spending plans.

Auditors have now warned the Scottish Government that ahead of next year’s budget, ministers and health chiefs should “jointly identify areas of limited clinical value and consider how services can be provided more efficiently, or withdrawn, to allow funding to be redirected”.

The report adds that a fundamental change in how NHS services are provided is “urgently needed”, making clear that without change being made “the NHS is unlikely to be able to meet growing demand”.

The alarm comes following analysis by the Institute of Fiscal Studies, published last week, that revealed health services in Scotland are lagging behind those in England.

Audit Scotland research has now concluded that commitments to reduce waiting lists and times have not been met, the number of people remaining in hospital because their discharge has been delayed is the highest on record, while NHS initiatives to improve productivity and patient outcomes have yet to have an impact and lack clear progress reporting.

Health accounts for around 40 per cent of the Scottish budget. Funding grew again in 2023-24 but has mostly been used to cover public-sector pay deals and inflation. Costs are forecast to continue to rise, which auditors warn makes savings challenging.

A lack of capital funding from Westminster has also forced SNP ministers to pause proposals to build new healthcare facilities including hospitals.

Stephen Boyle, Auditor General for Scotland, said: “To safeguard the NHS, a fundamental change in how services are provided remains urgent. The Scottish Government needs to set out clearly to the public and the health service how it will deliver reform, including how progress will be measured and monitored.

“Difficult decisions are needed about making services more efficient or, potentially, withdrawing those services with more limited clinical value to allow funding to be re-directed. Taking those steps will require greater leadership from Scottish Government and NHS leaders than we’ve seen to date.”

The warnings come as the Royal College of Physicians of Edinburgh, which represents thousands of doctors in Scotland, has called on the Scottish Government to invest in measures to reduce “delayed discharges”.

The organisation believes this could help people leave hospital sooner and free up much-needed hospital beds and reduce pressure on the hospital network.

As of September, there were 1,951 people delayed in hospitals across Scotland - equating to 59,033 days spent in hospital by people who didn’t need to be there - a 9 per cent increase on September 2023.

In a letter to the First Minister, the college has set out four measures which it believes the Scottish Government could introduce to reduce delayed discharges.

First Minister John Swinney | Andy Buchanan/PA Wire

The organisation wants SNP ministers to increase community care capacity to ensure patients have appropriate care options available upon discharge, as well as providing more support for family care-givers.

The college has also called for enhanced coordination between healthcare providers such as hospitals, social services and community care which could streamline the discharge process and reduce delays.

SNP ministers have also been urged to invest in technology to better track patient progress and discharge planning.

Professor Andrew Elder, president of the Royal College of Physicians of Edinburgh, said: “We have written to the First Minister about delayed discharges primarily because of the negative impact that unwanted and unwarranted hospital stays have on the physical and mental wellbeing of patients, particularly older people.

“However, it is also important to highlight that we can only address long waits in A&E and loss of elective surgical capacity in hospitals if we address the “back door” pinch points caused by discharge delays. Our hospitals will be unable to operate at their capacity until we improve this situation.

“Ahead of the budget, we’re calling for investment to meaningfully reduce delayed discharges to ensure that people are receiving care in the most appropriate setting, to free up hospital beds, and to reduce pressure on the entire secondary care sector.”

He added: “In order to do this, the Scottish Government must increase care capacity in residential and domiciliary settings, take steps to improve coordination between healthcare providers, invest in the right technology, and increase support for family carers – who provide an enormous amount of care already, but without sufficient recognition.

“If the Scottish Government is serious about creating a more efficient and patient-centred healthcare system, then delayed discharges must be dramatically reduced.

“This is not a new problem in Scotland – we would not tolerate such delays which affect many of our older people. The ageing of our population is a triumph and the lack of effective “social care” in Scotland risks turning that triumph into a disaster.

“Amidst a wide range of possible funding targets in health and social care, we believe that funding for the social care of older people must be a top priority.”

Health Secretary Neil Gray said: “I thank Audit Scotland for their report, and I agree that reform is essential.

“We know people are waiting too long for treatment but remain determined to reduce waiting times. Significant activity is underway through our £30 million investment to target pandemic backlogs. This will see around 12,000 additional new outpatient appointments, around 12,000 additional inpatient/day-case procedures and over 40,000 diagnostic procedures delivered.”

He added: “This year we are providing more than £19.5bn for health and social care and under this government funding for the NHS has increased in real terms by 30 per cent.

“But we are determined to continue to improve our NHS and the budget we set out tomorrow will throw the weight of the government behind performance improvements and ensure we can tackle the challenges in our health service.”

Mr Gray said that “health services everywhere face huge pressure in light of the pandemic”, adding that “ours is no exception”.

He said: “Our budget this week will have improving health and social care at its heart. We want to make progress on improving our NHS, but to do that, Parliament must approve our budget bill to unlock investment to drive long-term and lasting improvements – and the healthier population - that we all want to see.

“We are working with Cosla, local councils and Health Boards to reduce delayed discharges and escalate where we are not seeing the necessary improvements as a top priority. This year’s health and social care budget provides investment of over £1.7bn for social care and integration – an increase of over £800m compared to 2021-22.”

Scottish Government warned NHS may have to withdraw some services in cash crisis

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