Reduce reliance on financial support health boards told

In its annual review of the local NHS, the auditors said that half of all health service savings in 2018/19 were non-recurrent. At the start of the financial year, there was a rise in the number of boards predicting year-end deficits (nine compared with seven at the start of 2017/18) and total forecast deficits were higher than the previous year.

All health boards broke even in 2018/19, delivering an overall surplus of £4.6m. However, this was only possible due to additional financial support. Four health boards received a total of £65.7m in additional financial support to ensure overall break-even – up from £50.7m required by three boards in 2017/18.

The auditors said capital was an issue for health boards – capital budgets had decreased by 63% over the past 10 years and backlog maintenance stood at £914m.

The report acknowledged that the Scottish government had taken steps to help boards address the financial issues, as well as to improve access to care. These measures included moving from short- to medium-term financial planning. Financial plans and break-even arrangements are now over three years rather than one.

The government has also implemented a plan to improve waiting times and a scheme to develop NHS leaders.

However, Audit Scotland said it was too early to see the impact of these measures, adding that health and social care integration was too slow.

Without reform, the government predicts there will be a 10% shortfall in forecast health and social care funding by 2023/24 compared with demand. At this point, total funding is expected to be £18.8bn.

The report called for a new national health and care strategy and recommended that the government finalise a national capital investment strategy as a matter of urgency, to ensure capital funding is prioritised strategically.

It should also ensure health boards’ three-year plans are finalised before the beginning of each financial year. The plans should be routinely managed and monitored, and include steps to reduce boards’ reliance on additional financial support.

Caroline Gardner (pictured), the auditor general for Scotland, said: ‘The NHS in Scotland is running too hot, with intense pressure on staff and a service model that will remain financially unsustainable without a much greater focus on health and social care integration.’

She added: ‘We’re beginning to see examples of new ways of delivering healthcare, but they’re some distance from the system-wide reform the NHS needs. The challenge for the Scottish government and its partners will be to agree new priorities that enable large-scale change, which create a leadership culture that supports and respects all staff.’