Scotland’s new Cabinet Secretary for NHS Recovery, Health and Social Care has welcomed Audit Scotland’s latest NHS report which says ‘significant service transformation’ is needed – as he confirms he will soon share government plans for reform.

Meanwhile, opposition politicians say the national watchdog’s NHS in Scotland report spotlights a ‘catastrophic failure’ from government.

Audit Scotland’s 2023 report says the government needs an ‘overall vision’ for the NHS and is behind schedule on its NHS recovery plan, calling for a move from recovery to reform in the face of increasing demand and costs.

Responding, Cabinet Secretary Neil Gray has welcomed today’s publication:

“I am pleased to see Audit Scotland recognise the growth in funding for health and social care, the draft 2024-25 Scottish Budget provides over £19.5bn for health and social care.

“Although challenges and difficult decisions remain, this has given our NHS a real terms uplift in the face of UK government austerity.

“Overall, I welcome Audit Scotland’s report and the Scottish government will consider the recommendations outlined.”

These recommendations include a call for investment focused on preventative work to reduce long-term demand on the NHS.

The NHS Scotland 2023 report says that despite health funding increases and improvements in secondary care, activity has been ‘outpaced’ by increasing need and is yet to return to pre-pandemic levels.

Mr Gray says he will soon share a vision for NHS reform which will retain the fundamental free at the point of care principles of the NHS, while ensuring the service is sustainable into the future:

“The Scottish government is already taking forward a range of immediate and longer-term reform to our NHS, and I will set out my vision for further reform NHS in the coming weeks.

“The fundamentals of Scotland’s NHS will not change; we remain committed to free access to healthcare.

“Innovation also remains key in our efforts to meet demand and increase capacity and we recognise prevention is crucial in addressing the causes of ill health.”

Audit Scotland says government must publish a revised transparent medium-term financial framework for health and care, given the proportion of Scotland’s budget dedicated to health set to increase against a backdrop of compounding financial pressures.

Last year, the watchdog revealed the Scottish government faces a £1bn total budget shortfall as it called for urgent workforce reforms across the public sector.

Responding to today’s report, healthcare leaders have said the ‘bleak’ but unsurprising picture requires urgent action, focused on listening to the workforce and backed by funding.

The Scottish Labour conference last week heard plans for a clinician-led ‘revolution’ to renew the NHS which leader Anas Sarwar says will be bolstered by scraping the non-dom tax loophole to generate £134m a year, with a National Clinical Council advising ministers.

Now, Scottish Labour health spokesperson Jackie Baillie MSP says the report lays bare a “catastrophic failure” to remobilise the NHS post pandemic and that patients are paying the price:

“Audit Scotland reveals this government’s lack of ‘overall vision’ for the future delivery of healthcare in Scotland.

“Without a proper plan to support primary and social care, the situation in our NHS will only deteriorate.

“As our A&E departments overheat and almost 1 in 6 Scots languish on waiting lists, the cancellation of all infrastructure projects threatens to fan the flames of the NHS crisis.”

Scottish Conservative health spokesperson Dr Sandesh Gulhane MSP echoes this, saying the “utterly damning” report exposes the “monumental” failings on the NHS, adding:

“Neil Gray must urgently heed the warnings from Audit Scotland and outline a clear vision to support suffering patients and dedicated staff.”

Workforce reform

Meanwhile, Scottish Liberal Democrat leader and health spokesperson Alex Cole-Hamilton has called for “urgent investment” as staff and patients are waiting for NHS recovery and reform.

Today’s report outlines that despite NHS Scotland’s workforce increasing over the last five years, the number of vacancies remain high and absences have increased in 2022/23.

Cabinet Secretary Neil Gray says the government recognises that a sustainable NHS values its workforce, adding:

“Our workforce is at the heart of services that respond to changing demand. As such, we must deliver a sustainable, skilled workforce with attractive career choices and fair work, who are respected and valued for what they do.

“The NHS workforce is at record levels, and through meaningful engagement with trade unions and employers, we have secured pay agreements with both junior doctors and Agenda for Change staff, meaning we remain the only part of the UK to have avoided industrial action.”

Existing efforts to tackle systemic pressures in NHS Scotland are yet to be successful according to the Audit Scotland report, and wider, more rapid reforms are needed.

Beyond this, the report says a ‘shared sense of responsibility and collaboration across the whole system’ is required to effectively reform the NHS.

Read more: Health secretary promises reform for NHS; Urgent workforce reforms needed for Scotland's NHS; Economic change key to Scotland's health inequalities; Government to launch ‘conversation’ on future NHS; Who is Scotland’s new health and care secretary?

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