Audit Scotland’s latest annual assessment of the NHS in Scotland calls for more transparency amid unprecedented and growing financial and operational challenges facing the service, which could leave many of the Scottish government’s NHS recovery plan ambitions unmet.

Regarded by BMA Scotland as a ‘damning’ report, the doctors’ union – alongside the Royal Colleges of Nursing and Physicians – says the Scottish government must act with urgency to support staff.

The Auditor General’s report lays bare the challenges facing Scotland’s NHS, stating that the Scottish government needs to be transparent about how long it will take to recover from initial pandemic waves and reform services.

This most recent report on the NHS in Scotland assesses the progress, recovery efforts and plans as well as the outstanding challenges from 2022.

Scotland’s NHS recovery plan, published in 2021, aimed to reduce the rising waiting times, address the workforce crisis and improve overall activity and delivery of services.

When published, the recovery plan promised to deliver substantially increased activity from pre-pandemic levels ‘as quickly as possible’ over the next five years – which faced backlash from unions concerned about setting unrealistic expectations among the public.

Now, the Auditor General, Stephen Boyle says the government must explain more clearly the challenges facing the NHS and what the public can expect:

"NHS staff remain under severe pressure and the Scottish government is facing tough choices.  

“Money is tight but investment is needed in recovery. That means ministers have to prioritise which NHS aims can realistically be delivered. And they need to be more transparent about the progress they're making. 

"The Scottish government has set out the big challenges facing the NHS. But it also needs to clearly explain to the public what those challenges mean for the level of service they can expect, including waiting times." 

A huge backlog of people waiting for healthcare across the NHS has continued to increase in the 18 months since the plan was published, as the NHS deals with a range of financial and operational pressures.

The report raises concerns for both staff and patients, pointing to severe pressures on services due to staffing levels, vacancy rates and staff wellbeing. Scotland's most recent NHS Agenda for Change pay offer establishes an average 6.5% pay uplift and attempts to address vacancies among higher band nurses.

Reponses to the report from unions and MSPs share the Auditor General’s call for more clarity on the government’s plan of action to address the backlog and other pressures facing the NHS.

The report references RCN Scotland’s survey finding that 86% of respondents felt that staffing was not sufficient on their last shift to meet the needs of patients.

Director for RCN Scotland, Colin Poolman says Audit Scotland’s new report highlights safe staffing is vital for recovery:

“This report is clear that tackling the workforce crisis is key for NHS recovery. We need effective workforce planning that is based on population need, implementation of Scotland’s safe staffing legislation and fair pay that truly reflects the safety critical role that nursing staff play.

“We completely agree that there also needs to be an open and honest discussion about the ongoing level of investment, and new ways of working, that will be required to meet the growing demands on Scotland’s health and care services.”

He says a Nursing Retention Strategy must be a priority for the new Nursing Taskforce – echoing RCN's call for clearer investment in nursing ahead of Holyrood’s budget debate.

Addressing Scotland’s Policy Conference last year, Health Secretary Humza Yousaf shared that “work is well underway to provide a healthy labour supply” as part of the NHS recovery plan.

Yet, with health boards struggling to recruit the necessary doctors, nurses and other health professionals needed to ensure long-term service stability, the report states that some key targets are unlikely to be met.

While some progress has been made against the recruitment targets set out in the NHS Recovery Plan, boards are struggling to grow their workforce numbers as high as expected.

The report states that workforce capacity remains the ‘biggest risk’ to NHS recovery – with the recruitment of 800 additional GPs by 2027 now seeming improbable.

With inflation and recurring pay pressures alongside continual COVID-related costs and the fuel crisis, the report acknowledges the ‘significant and growing financial pressures’ facing the government and NHS boards.

The RCPE says that, given the “fraught and financially stretched” landscape, the College believes the government must reconsider its timeline for the NCS. Unions and charities have already called for a pause to plans, to provide more time for co-development and funding assessments.

While the Auditor General says the Scottish government is showing early signs of developing innovation and reform ‘essential’ for creating a more sustainable NHS, it is too early to assess its impact.

The report urges the government to make information on how long people will have to wait for treatment clearer and more meaningful as it continues with its NHS recovery plan.

In an FOI release to healthandcare.scot, emails between government officials revealed a scrambled to meet the self-imposed 100-day deadline, including late-night revisions made by the First Minister.

Today’s Audit Scotland report says the short self-imposed target to publish the recovery plan has likely contributed to its slow progress, with important capacity and demand modelling not taking place beforehand. The Scottish government was also unable to fully engage with NHS boards while preparing the plan, according to the report.

A mismatch between local and national need has also been an issue, says the Auditor General, especially in workforce planning for areas soon due to host now-delayed National Treatment Centres (NTCs).

Simon Barker, Deputy Chair of BMA Scotland, says workforce data is needed to improve the situation across Scotland:

“Demand is outstripping capacity and the NHS in simply cannot deliver what it is asked to under its current limitations, so there must be action if we want to ensure it is put on a sustainable footing for generations to come and stays true to the fundamental value of remaining free at the point of delivery.

“I back Audit Scotland’s repeated call for the Scottish government and NHS boards to improve the availability, quality, and use of workforce data to ensure workforce planning – which is currently abysmal – is based on accurate projections of need. BMA Scotland has highlighted that the actual consultant vacancies in Scotland appear to be much higher than the official government figures claim.”

Age Scotland, RCN Scotland and the RCPE share this call for the government to provide clearer recovery plans, with RCPE specifically calling for “open and honest” communication from both the UK and Scotland going forward.

Read more: Staff shortage concerns in latest MWC reviews; RCN: Staff need to see light at the end of the tunnel; Mr Yousaf: “Scotland is a great place to work”; Emails show haste to publish recovery plan; New ‘record' pay offer for 160,000 NHS staff

Sign up to our bulletin for key health & social care updates straight to your inbox and you can follow healthandcare.scot on Google News.