Warning Scot Govt has 'no clear plan to deliver NHS vision'

The report notes that the NHS Scotland is still seeing fewer patients than it was pre-pandemic despite increasing funding and staffing, but adds that recent increases in investment have been mostly swallowed up by pay rises for staff and inflation.

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With costs "forecast to continue rising", Audit Scotland says the Scottish Government must "clearly explain to the public how it will reform the NHS" as well as placing an "increased and ongoing focus" on improving population health in order to reduce pressure on the health service. 

It states: "The affordability of healthcare spending is now an urgent issue that the Scottish Government must address.

"The scale and pace of reform needs to increase.

"Difficult decisions need to be made about transforming services, and potentially about what the NHS stops doing.

"This will be essential for managing the demands placed on the healthcare system and ensuring its future sustainability."

Health boards in Scotland are forecast to have a total deficit of £424m in 2026/27 despite making cuts of £438m, with an increasing reliance on non-recurring savings (Image: Audit Scotland) First Minister John Swinney has pledged to prioritise the NHS in tomorrow's Scottish Budget, insisting that he has "thrown the weight of the Scottish Government behind tackling some of the key challenges it faces" since taking over as SNP leader in May.

However, the Audit Scotland report comes days after a damning analysis by the Institute for Fiscal Studies highlighted that the NHS in Scotland is recovering much more slowly than England in terms of elective activity, and that on many measures - including waiting lists - it had actually worsened over the past year. 

Audit Scotland reiterates this message, noting that "progress to reduce the backlog of care has been slower than anticipated". 

The report adds: "National commitments to reduce waiting lists and waiting times have not been met, and reducing delayed discharges remains an intractable problem.

"NHS Scotland has implemented a range of projects and initiatives aiming to improve productivity and outcomes for patients but as yet these are having little impact on headline indicators, and there is a lack of clear and transparent reporting of progress, and evaluation of impact."

The number of people undergoing planned procedures is still lower than it was pre-pandemic, and much lower compared to 2013, but fewer patients are getting their operations within Scotland's 12-week Treatment Time Guarantee (Image: Public Health Scotland) Health accounts for about 40% of the overall Scottish budget, and around half of day-to-day spending in the public sector. 

Meanwhile, work to complete the network of National Treatment Centres remains paused as a result of capital budget constraints. 

Audit Scotland said the Scottish Government’s restated vision for health and social care is "not clear" on how these various operational pressures on the NHS will be addressed or how reform will be prioritised.

It calls on the Government to work with NHS staff, partners and the public to set out a clear delivery plan and make tough decisions about how it may change or potentially even stop some services.

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Stephen Boyle, Auditor General for Scotland, said: “To safeguard the NHS, a fundamental change in how services are provided remains urgent.

"The Scottish Government needs to set out clearly to the public and the health service how it will deliver reform, including how progress will be measured and monitored.

“Difficult decisions are needed about making services more efficient or, potentially, withdrawing those services with more limited clinical value to allow funding to be re-directed.

"Taking those steps will require greater leadership from Scottish Government and NHS leaders than we’ve seen to date.”

Sandesh Gulhane, the Scottish Conservative's health spokesman, said the SNP was "out of ideas". 

He said: “In the week of the Budget, this report should be an urgent wake-up call for the SNP to ensure that money is invested in the right areas of our NHS, to ease the burden on patients and staff suffering due to their incompetence.”

Health Secretary Neil Gray said funding for the NHS has increased in real terms by 30% under the current government but he agreed with Audit Scotland that "reform is essential".

He added: “We know people are waiting too long for treatment but remain determined to reduce waiting times.

"Significant activity is underway through our £30 million investment to target pandemic backlogs.

"This will see around 12,000 additional new outpatient appointments, around 12,000 additional inpatient/day-case procedures and over 40,000 diagnostic procedures delivered."