Immediate action is needed to shift the NHS towards long-term, fundamental change.
In her annual review of the NHS, the Auditor General for Scotland finds that performance continued to decline in 2017/18 and the NHS is not financially sustainable in its current form. Pressure is building in several areas, including major workforce challenges, rising drug costs and a significant maintenance backlog.
In 2017/18 the health budget was £13.1 billion – 42 per cent of the total Scottish budget. Taking into account inflation, this was a 0.2 per cent decrease from 2016/17. NHS boards struggled to achieve unprecedented savings of £449.1 million, relying heavily on one-off savings.
No NHS boards were able to meet all eight key national targets and performance against these targets declined nationally. More people waited longer for outpatient and inpatient appointments. Only one of the eight key performance targets was met nationally.
The NHS also faces significant workforce challenges, with difficulties recruiting and increases in sickness absence and staff turnover. There is evidence that the NHS is struggling to recruit and retain the right people, and ensure they have the time and support they need. Boards are also considering the potential impact of EU withdrawal on areas such as staffing, the supply and cost of drugs, and food prices.
The Scottish Government wants to transform the healthcare system so that everyone can live longer, healthier lives at home or in a homely setting by 2020. Significant activity is underway to work towards this, but progress is too slow.
The Scottish Government's recent health and social care medium-term financial framework and other measures are welcome steps, but more needs to be done. Audit Scotland will be carrying out further work to understand how this new approach will work in practice.
Caroline Gardner, Auditor General for Scotland, said:
"The performance of the NHS continues to decline, while demands on the service from Scotland's ageing population are growing. The solutions lie in changing how healthcare is accessed and delivered, but progress is too slow.
"The scale of the challenges facing the NHS means that decisive action is needed now to deliver the fundamental change that will secure the future of this vital and valued service. 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 to people's lives. This will help to build support among the public and politicians for the changes required."