The Scottish government needs to develop a longer-term approach to NHS financial planning to allow NHS boards and integration authorities the flexibility to develop more community-based services, Audit Scotland’s annual report on the NHS says.
The report says patients in Scotland are waiting longer for treatment than in previous years, the NHS is missing seven out of eight performance targets and struggling to maintain quality.
For example, the number of people waiting for their first outpatient appointment increased by 15% in the past year and there was a 99% increase in the number of people waiting more than 12 weeks.
Life expectancy is lower than in most European countries and improvements have stalled in recent years. Drug-related deaths increased significantly in 2016–2017 and are now the highest in the EU.
NHS boards are finding it more and more difficult to identify one-off-savings, and struggling to recruit and retain staff, particularly GPs, the report says.
“Previous approaches such as providing more funding to increase activity or focusing on specific parts of the system are no longer sufficient. Attention needs to focus on overcoming a number of barriers to change. Managing the health budget on an annual basis is hindering development of longer-term plans for moving more care out of hospital.”
Health budget savings
In 2016–2017, the health budget, at £12.9bn, represented 43% of the total Scottish government budget and although NHS boards made unprecedented levels of savings in 2016–2017 — £387.4m (3.8% of total revenue allocations) — the NHS fell short of its saving target of £406.3m by 4.7% (£18.9m). The 2017–2018 health budget is £13.1bn, an increase of 1.5% in cash terms, and a decrease of 0.1% in real terms from 2016–2017.
In 2011, the Scottish government published its 2020 Vision for transforming healthcare and the health of the population. Its aim is that everyone should live longer, healthier lives at home or in a homely setting by 2020. In December 2016, it published its health and social care delivery plan 2016 to set out how the 2020 Vision will be achieved, but the report says that many of the actions in the action plan “are statements of intent rather than actions” and that it does not set out in detail how they will be achieved.
Responding to the report, Scotland’s health secretary Shona Robison said: “We’re working to develop a medium-term financial framework, within the context of the budget settlement that the Scottish Government receives. This will be to outline the broad direction for the NHS and care services to meet the changing needs of the people of Scotland, including shifting the balance of care towards community health services.”