Recovery difficult for Scotland’s NHS

In a report, NHS in Scotland 2020, the auditor said the NHS and Scottish government took early action during the first wave of the pandemic in 2020 – increasing capacity and pausing non-urgent treatments, for example. A number of innovations, such as the huge rise in video consultations, were implemented, and together with other measures ensured the NHS was not overwhelmed. However, the report also concludes that both the government and NHS Scotland could have been better prepared.

Covid-19 had exacerbated existing financial and operational issues, with boards finding it difficult to hit waiting times targets before the pandemic. A new approach to tackling waiting, based on clinical priority, has been launched, but the report warned that timescales for the new priority levels are ambitious, particularly as a significant backlog has built up.

The pandemic is forecast to cost the local NHS £1.67bn in 2020/21, made up of £1.56bn in revenue and £112.2m in capital costs. The highest revenue costs are for personal protective equipment (£324.5m), Covid testing (£89.7m), and additional hospital bed capacity (£70m).

Temporary staffing costs increased in 2019/20 – bank nursing from £165m in 2018/19 to £180m and medical locum costs from £99.9m to £102.9m. Agency nursing costs were not available for 2019/20.

Covid-19 related costs will be covered by the UK government, but the report said there is uncertainty over the funds that will be available for Covid costs in the longer term.

Financial balance

While most NHS boards achieved financial balance in 2019/20, four needed additional financial support from the Scottish government. The report said responding to the pandemic had led to significant additional expenditure and there is uncertainty over the longer-term financial position.

The pandemic has also affected savings plans. The government’s health and social care medium-term financial framework identified the need to save £1.7bn between 2016/17 and 2023/24. But Covid has affected health boards’ ability to meet the trajectory set out in the framework, and the government is committed to reviewing the trajectory in 2021/22 to consider the impact of the pandemic.

Taking an approach agreed with NHS finance directors the government revised NHS boards’ allocations for 2020/21, taking into account additional Covid costs. A further £1.6bn has been allocated overall, and, with Covid costs affecting boards’ ability to deliver financial recovery plans, boards will be fully funded to deliver financial balance in 2020/21. This will be reviewed in 2021/22 to take account of any ongoing impact of the pandemic.

The report made a number of recommendations, including the need to align priorities with the NHS Scotland remobilisation framework, update the integrated workforce plan taking account of how services will be delivered differently in the future, and monitor and report on measures introduced to support staff health and wellbeing.

Stephen Boyle (pictured), Auditor General for Scotland, said: ‘NHS staff have shown extraordinary commitment to treating and caring for Scotland's people during a pandemic that has highlighted the need to deal with long-standing health inequalities.

‘Getting the full range of health services back up and running will be challenging. But there are clear lessons to be learned from the pandemic, both in how the country could have been better prepared and in the innovation that we've seen. It's essential that these advances are now retained and built upon.’

BMA Scotland chair Lewis Morrison said it was clear that the Scottish government could have been better prepared and welcomed the proposal to monitor and report on the effectiveness of the measures introduced to support the health and wellbeing of NHS staff.

He added: ‘It is concerning that the existing financial and operational challenges in the NHS have since been exacerbated by Covid-19 – particularly given how serious the warnings from Audit Scotland have been in previous reports. It absolutely underlines our long-held view that the NHS is substantially underfunded. Going forward we need an honest conversation with the public about what our NHS can deliver, within the resources we are able or willing to make available to it.’

Dr Morrison agreed that restarting services will be a substantial challenge, and NHS leaders must work collaboratively across public services to deal with the ongoing challenges caused by Covid. Giving staff a break must be a priority, he added.