Swift changes needed to boost Scotland finances

In its annual review of the health service, the auditors said the NHS faced mounting workforce challenges, rising drugs costs and a significant maintenance backlog. Though at £13bn, health spending accounted for 42% of the total Scottish budget, the 2017/18 health budget was a 0.2% real-terms decrease on the previous year. Health boards struggled to deliver ‘unprecedented’ savings of £449m and relied on non-recurrent savings.

Performance deteriorated in 2017/18 – no board achieved all eight national targets and performance against these targets declined, with more people waiting longer for outpatient and inpatient care.

Audit Scotland welcomed recent announcements by the Scottish government of a medium-term financial framework for health and social care and measures to put health boards on a better financial footing (see Flexible future, November 2018). However, it said a robust and transparent financial management system must be implemented to manage and monitor boards’ new year-end flexibilities. Audit Scotland will carry out further work to examine how the new approach will work in practice.

It said capital funding should be prioritised through a national capital investment strategy, while the government should continue to develop comprehensive workforce planning.
Caroline Gardner, auditor general for Scotland, said the problems of declining performance and increasing demand would be solved by changing how healthcare is accessed and delivered. But progress is too slow.

‘Decisive action is needed now to deliver the fundamental change that will secure the future of this vital and valued service,’ she said. ‘Alongside longer term financial planning, this must include effective leadership and much more engagement with communities about new forms of care and the difference they make. This will help to build support among the public and politicians for the changes required.’

Health secretary Jeane Freeman said the government was acting on the recommendations. It intends to invest £850m over the next three years to reduce waiting times.