The public spending watchdog, Audit Scotland, laid bare a litany of problems in its report, including tightening budgets, rising costs, higher demand for services, pressure to meet targets and increased staff vacancies.
Medical leaders called for “substantive action” to be taken in the wake of today’s publication, while opposition MSPs called it a “damning analysis” and accused the Scottish Government of operating “a sticking-plaster approach” to problems within the NHS.
The document, entitled NHS in Scotland 2015, warned that the NHS would not be able to continue providing its current level of service unless profound changes were made.
It found that Scotland’s health budget decreased by 0.7 per cent in real terms in 2014-15, as boards struggled to meet a string of demanding targets while remaining within budget.
There has been a “general decline in performance in recent years” as only two out of nine key performance targets were met within the time period, the report found.
Deep-rooted recruitment and staff retention issues have led to a 53 per cent increase in the use of private agency staff and a 22 per cent rise in locum doctors.
Auditors also warned that the Scottish Government has not made sufficient progress towards its 2020 vision to change the balance of healthcare to more community-based settings.
The Auditor General for Scotland, Caroline Gardner, said: “We have highlighted concerns around targets and staffing in previous reports. These have intensified over the past year as has the urgency for fundamental changes such as introducing new ways to deliver healthcare and developing a national approach to workforce planning.
“It is important that the Scottish Government and health boards work closely together to help alleviate these pressures and also increase the pace of change necessary to meet its longer-term ambitions.”
The watchdog hailed the fact that health boards achieved an underspend of £10 million after spending £11.4 billion in 2014-15, which they said was “commendable given the financial challenges faced”.
However, most boards were relying on one-off savings or funding from Holyrood to break even, such as NHS Tayside which has received emergency cash loans for the past three years.
Jackie Baillie, Labour’s public services spokeswoman, said: “For our NHS to be suffering across such a broad ranges of issues, affecting so many health boards, shows that these are not isolated incidents but a fundamental problem with how the SNP have managed our NHS.
“For years the SNP have protested that they were protecting the health budget – today’s expert report shows that the health budget decreased on their watch.
“The SNP government has presided over a target-driven culture in our NHS and then failed to resource our health service properly so that seven out of nine of these targets have seen a performance that just isn’t good enough.
“This sticking-plaster approach cannot continue. It’s time for the SNP government to get a grip and deliver an NHS fit for the future.”
Liberal Democrat spokesman Jim Hume said: “The findings of this latest report are stark: unless SNP ministers get a grip, the 2020 vision will not be achieved.
“NHS boards have been forced to scramble to address staff shortages and short-term arrangements have replaced long-term planning. This is clearly not sustainable.”
Dr Peter Bennie, chairman of BMA Scotland, warned that rising numbers of vacancies coupled with an ageing population was creating an impossible situation.
He added: “The overriding message that must get through from this report is that substantive and realistic action is needed if our health service is to cope with the rapidly increasing pressures it is facing.”
Nursing leaders also called for performance targets to be abolished. Ellen Hudson, Royal College of Nursing (RCN) Scotland’s associate director, said: “If we are to put the NHS on a sustainable footing, then the government needs to take heed of the recommendations in this report and listen to what we and many other organisations have been saying for some time about the pressures on our health services.
“And it really needs to step up the pace and bring a much more joined-up approach to support long-term change.”
Health secretary Shona Robison said the government was carrying out “far-reaching reforms” and highlighted its £60m investment to address workload and recruitment in primary care, as well as £200m to create six elective treatment centres.
She added: “Scotland’s NHS is now performing better against tougher targets and, as Audit Scotland highlights, we have a record high workforce and the level and quality of care provided to patients has contributed to people living longer along with continued advances in diagnosis, treatment and care.”