Scotland’s Auditor General says NHS Scotland has to transform in the face of increasing demand and costs, if it is to remain financially sustainable.

The national watchdog’s report says, despite a range of strategies, plans and policies, the Scottish government has provided no overall vision for the future of the health service.

Audit Scotland’s latest annual assessment of the NHS, published today, highlights increased reliance on agency staff and finds many areas of the government’s NHS recovery plan ‘behind schedule’.

It concludes that the government must move from recovery to reform, saying ‘significant service transformation’ is needed to secure the financial sustainability of the health service according to Audit Scotland – as the NHS is failing to meet growing demand.

Despite improvements in secondary care in 2023, the workforce remains under pressure both from operational challenges and patient need.

The report details that activity in hospitals has been ‘outpaced’ by increasing need so secondary care has still not recovered to pre-pandemic levels.

While the government has produced a number of strategies and plans to deliver for Scotland’s healthcare, Audit Scotland says there is ‘no overall vision’.

Stephen Boyle, Auditor General for Scotland, said:

“Without change, there is a risk Scotland’s NHS will take up an ever-growing chunk of the Scottish budget. And that means less money for other vital public services.

“To deliver effective reform the Scottish government needs to lead on the development of a clear national strategy for health and social care.  

“It should include investment in measures that address the causes of ill-health, reducing long-term demand on the NHS. And it should put patients at the centre of future services.”

This comes a year after the body called for more transparency and clarity from the government on the actions it has planned to tackling the challenges facing the NHS.

Spending and systemic pressures

In October 2023, Audit Scotland called for urgent workforce reforms across the public sector as it revealed the government faced a £1bn budget shortfall.

While avoiding expensive strike action by meeting NHS staff pay increases, Westminster’s inaction to meet doctors demands meant the Scottish government had to find the increased pay in its existing budget.

Increasing costs since from inflation have added to the financial pressure the NHS was already facing, says Audit Scotland. The report recommends that government develops a national NHS investment strategy to prioritise funding.

Moreover, Audit Scotland says, the government must publish a National Workforce Strategy for health and social care and revisits its NHS recovery plan timeframes.

January saw a landmark commitment to building National Treatment Centres placed on pause while last week’s Scottish Labour conference heard pledges for a clinician-led ‘revolution’ of the NHS.

Despite health funding increasing, net expenditure was found to be down in 2022-2023 compared to 2021-2022. Audit Scotland warns that the government must provide transparent medium-term financial plans for 2024.

The report says health spending made up 39% of the government’s overall 2022/23 budget, a real terms increase of 21% since 2013/14.

While the workforce in Scotland’s NHS has increased over the last five years, the number of vacancies remain high and staff turnover and absences have increased in 2022/23.

Audit Scotland notes that the government promised a National Conversation on the future of the NHS, and suggest that developing a clear national strategy for health is ‘increasingly important given the proposed development of a National Care Service’.

Although it recognises ‘focused work’ to tackle the challenges facing the NHS, the report highlights that several systemic pressures in NHS Scotland ‘remain unsolved’ as of autumn 2023.

Changing the outlook, it says, will rely on ‘wider and more rapid reform’ of services, investment in preventative measures and shared responsibility and collaboration across the whole system.

The report recommends the government sets out a new long-term vision for the wider health system by 2025, with clear national priorities and works alongside NHS boards to progress on existing action plans.

By doing this, Audit Scotland highlights that staff could be empowered to take advantage of ‘innovative opportunities’ for service reform and transformation.

Read more: Urgent workforce reforms needed for Scotland's NHS; RCN: Staff need to see light at the end of the tunnel; Staff shortage concerns in latest MWC reviews; Doctors ‘deeply concerned' for care homes over winter; Mr Yousaf: “Scotland is a great place to work”; Auditor General: Difficult choices for Scotland's NHS

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