Auditor General: Scotland's NHS is 'not financially sustainable'

Audit Scotland says there is uncertainty about the longer-term financial position of the health service.

Scotland’s NHS is ‘not financially sustainable’ and pandemic has increased pressures, warns spending watchdog iStock

The NHS is ‘not financially sustainable’ and remains on an ’emergency footing’, according to Scotland’s spending watchdog.

In a new report, Audit Scotland explained that rising spending on the health service was “unsustainable”.

And it warned that in responding to variants of Covid-19, a growing backlog of patients waiting longer for treatment had been created.

The backlog poses a “significant risk” to the Scottish Government’s recovery plans, the watchdog indicated.

Improving the NHS against the competing demands of the pandemic, as well as an increasing number of policy initiatives such as plans for a National Care Strategy, will also be “very difficult”, the report found.

In its financial assessment of the health service, Audit Scotland stated that the NHS was “not financially sustainable” before the pandemic, and that responding to the pandemic has increased those pressures.

Audit Scotland said the heavy burden on frontline staff had impacted their wellbeing. (iStock/bymuratdeniz)iStock

The spending watchdog noted that whilst £2.9bn was allocated by the Scottish Government during 2020/21 to cover pandemic-related costs, as well as additional funding having been committed for health and social care in 2021/2022 and beyond, there is “still uncertainty” about future Covid-19 funding levels and the longer-term financial position.

The ability of the health service to plan remains hindered due to a lack of robust and reliable data, including workforce, primary care, community, social care, and health inequalities data, Audit Scotland noted.

NHS and social care workforce planning has also “never been more important”, the watchdog said, urging the Scottish Government to prioritise addressing workforce availability challenges.

The report further noted that frontline NHS and social care staff, leaders and civil servants have shouldered a “heavy burden” over the last two years, with the pandemic having affected their wellbeing.

In setting out its recommendations, Audit Scotland called for reform to the NHS, and suggested that there is a “clear opportunity” to do things differently going forward.

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.”

Scottish Conservative MSP Dr Sandesh Gulhane described the report as 'damning'. (STV News)STV News

Scottish Conservative health spokesman Dr Sandesh Gulhane criticised health secretary Humza Yousaf and the SNP over the state of the health service in the country.

“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,” he said.

“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.”

Gulhane also said that he has “no confidence” in the SNP or in the health secretary.

He said: “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 Labour accused the SNP of having 'entirely failed' to support the NHS properly. (STV News)STV News

Scottish Labour health spokesperson Jackie Baillie also took aim at the record of the SNP in government.

“This scathing report is a damning indictment on almost a decade and a half of SNP mismanagement of our NHS and care sectors,” she said.

“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. 

“The failure of 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.”

Baillie insisted that her party has “the plan and the ambition” to get the NHS back on track.

She said: “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.” 

“The Scottish Government must improve recruitment and retention to maintain safe levels of care.”

Gillian Mackay, Scottish Greens MSP

Scottish Greens health spokesperson Gillian Mackay explained that existing staff must be “properly supported”, with many feeling burnt out and exhausted due to the pandemic.

“Our NHS is under more pressure than ever before as staff deal with the effects of the pandemic while continuing to deliver routine healthcare,” said Mackay.

“This report clearly sets out that the Scottish Government must improve recruitment and retention to maintain safe levels of care.

“It’s vital that workforce planning reflects the new reality, to make sure services have the staff they need to care for generations to come.

“Existing staff must also be properly supported. They have been working in extremely difficult conditions for two years now and many are feeling exhausted and burnt out.

“The Government must focus on promoting workforce wellbeing so that we do not haemorrhage staff as we begin to recover from Covid-19.”

The Scottish Greens have said staff must be 'properly supported'.iStock

Health Secretary Humza 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 7600 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.

“We also welcome Audit Scotland’s recognition of the actions taken to save lives during the pandemic through the vaccination programme, continued prioritisation of cancer services and Test and Protect. The report shows we worked quickly to support staff wellbeing – introducing a range of measures backed by £12m investment, in addition to funding the recruitment of additional staff across a variety of health and care services.

“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% more – £2.5bn – in our NHS will support recovery and reform; delivering a more sustainable health and social care system that reduces inequalities and promotes good health.” 

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