NHS Under Pressure

The NHS in Scotland is facing significant pressures from increasing demand for services, that's according to Audit Scotland.

The public spending watchdog says health boards are also trying to achieve challenging performance targets while working with tightening budgets.

A reports says that NHS boards are finding it increasingly difficult to cope with growing pressures, which will considerably test their ability to deliver a national policy to move more services into the community by 2020. 

All health boards met their financial targets in 2013/14, but several needed additional funding from the Scottish Government or relied on non-recurring savings. NHS boards' revenue budgets increased by just over one per cent in real terms in 2013/14, and smaller real terms increases are planned from 2014/15 onwards. NHS Fife has had to borrow an additional £2.5 million since 2011 due to overspending.

The report notes that demand for services is rising due to demographic changes, particularly the increasing ageing population of Scotland, the number of people with long-term health conditions and people's expectation of healthcare. Despite substantial efforts, the NHS did not meet some key waiting time targets in 2013/14. Increasing numbers of people being admitted to hospital from A&E, rising numbers of delayed discharges and more demand for outpatient appointments are adding further pressures on services by creating blockages in the system. 

The Auditor General for Scotland, Caroline Gardner, said: "Pressures on services and finances in the health service have been building steadily in recent years. Audit Scotland has previously reported on this increasing strain, and emphasised the need for a focus on long-term financial planning. 

"NHS boards need to deliver major changes to meet the future needs of patients. The effort invested in meeting annual targets, within tightening budgets, makes it difficult for NHS boards to reshape care in line with an ambitious national policy. The Scottish Government should review whether the current financial and performance targets for the NHS can be achieved at the same time as implementing its vision for health and social care." 

Health Secretary Alex Neil today pledged to continue protecting Scotland's NHS following the report and said that NHS revenue budget has increased by £256 million and is set to rise further, taking health spending above £12 billion for the first time. 

Mr Neil confirmed the Scottish Government will refresh the strategy for achieving its 2020 vision for the NHS to ensure that it reflects the increasing demands from patients and the new way services will be delivered under health and social care integration.

He said: "Protecting front-line health services is an absolute priority for this government, and we will do this by increasing the NHS front line budget despite cuts in the overall budget from Westminster.

"The NHS is not perfect, and we’re always seeking to make improvements. I am immensely proud of the care it delivers, day in, day out, to thousands of people right across Scotland.

"This report highlights the pressures the NHS is facing as it continues to treat more people than ever before, who have more long term conditions. Audit Scotland rightly notes that the Scottish Government recognises these issues and has set out a long-term vision for the NHS.

"But we need to make sure our plan develops to meet the changing needs of the people of Scotland and delivers our overall objectives of being a top modern healthcare service that provides quality care, improves the health of the Scottish public and tackles inequalities. 

"By evolving the long-term plan for NHS Scotland, this Government will ensure that Scotland continues to have an NHS that it can be proud of today and in the future.

"The NHS is one of Scotland's greatest success stories, and I hope stakeholders and politicians from across Scotland can get involved in this process, just as we have invited them to in the past, and we will publish an update to our 2020 vision in the new year."

Scottish Liberal Democrat health spokesperson Jim Hume MSP said:

"This eye-opening report shows that the SNP Government's cuts agenda to the NHS is coming down the hill when health boards are already teetering on the brink. A near one percent cut in real terms over the next two years could knock them over.

"We know from experience that these cuts could be damaging because health boards like NHS Orkney, NHS Grampian and NHS Highland have historically been underfunded by the centralising SNP government. This independent report shows that NHS Grampian is being starved of £39.9million in 2013/14 alone.

"It is a disgrace that health boards are then being forced to go cap in hand to the SNP government when the SNP government are yet to give health boards their full resource allocation.   

"This is not sustainable or fair for patients in the North and only results in worsening performance against crucial waiting times. 

"People will wonder why the SNP government are forcing Scotland's health service to limp on from year to year at a time when they should be strengthening its defences for the greater challenges of the future. This short-sighted approach has been proven to be bust through failing performance against a range of waiting times, staff shortages and an over-reliance on costly locum staff. Scottish Liberal Democrats have gladly supported Vision 2020 but it seems the only blockade to its success is the SNP government."