Audit Scotland says the government has ‘no clear plan’ to deliver its vision to reform NHS Scotland and address service pressures, reduce waiting lists and improve patient outcomes.

The public sector watchdog says that the NHS in Scotland is yet to fully recover from the COVID-19 pandemic in terms of the number of patients it is seeing while government targets for increasing productivity have not been met despite extra funding.

Scotland’s health secretary has responded by saying that this week’s budget will “throw the weight of the government” behind the NHS.

In a report published today, Audit Scotland says the government must now outline a clear action plan to address the pressures facing staff and services, and show how it intends to prioritise reform.

Stephen Boyle, Auditor General for Scotland, says “fundamental change” in how services are provided is urgently needed to safeguard the NHS in Scotland:

“The Scottish government needs to set out clearly to the public and the health service how it will deliver reform, including how progress will be measured and monitored. 

“Difficult decisions are needed about making services more efficient or, potentially, withdrawing those services with more limited clinical value to allow funding to be re-directed.

“Taking those steps will require greater leadership from Scottish government and NHS leaders than we’ve seen to date.”

Today’s report echoes the findings of its annual review of NHS Scotland this year, which concluded that the government had ‘no clear vision’ of NHS reform to meet need in a landscape of growing demand outpacing progress.

The Scottish government has since renewed its commitments to reduce waiting lists and waiting times and to produce a vision for NHS reform that would be informed by both the workforce and public.

Recent analysis revealed NHS Scotland is ‘lagging’ behind NHS England in terms of recovery, with a conference looking at waiting lists and beyond hearing that Scotland's only success has been in reduced waits for diagnositc tests.

While health remains the single biggest spend at £19.1bn in 2023/24, Audit Scotland says today that late funding allocations and uncertainty has continued to make in-year financial planning more difficult for health boards.

Health accounts for about 40% of the Scottish budget and spending is set to grow again next year, though much of the increased funding will go on meeting pay commitments and inflation, putting ‘pressure on other public services’.

In response, Scotland’s Cabinet Secretary for Health and Social Care, Neil Gray has agreed that “reform is essential”, telling healthandcare.scot:

“We know people are waiting too long for treatment but remain determined to reduce waiting times.

“Significant activity is underway through our £30m investment to target pandemic backlogs.

“I am encouraged to see in the annual Scottish Household Survey, published today, an increase in satisfaction levels in local health services. The overwhelming majority reported being treated with dignity and respect when accessing those services – we are determined to do more.”

With costs forecast to continue rising, the national watchdog says that making savings will remain challenging and the government must work with staff, partners and the public to make ‘tough choices’.

Audit Scotland says services may need to change or potentially stop as part reform and – as it has previously recommended – the government should publish ‘clear and transparent’ progress reports on NHS reforms and a delivery plan that clearly explains to the public how it will reform the NHS and address the pressures on services.

The watchdog says the government must improve its communication around progress, adding that NHS initiatives to improve productivity and patient outcomes have lacked clear progress reporting.

The health secretary says that the budget published this week will “throw the weight of the government” behind improving the health service:

“This year we are providing more than £19.5bn for health and social care and under this government funding for the NHS has increased in real terms by 30%. 

“But we are determined to continue to improve our NHS and the budget we set out tomorrow will throw the weight of the government behind performance improvements and ensure we can tackle the challenges in our health service.”

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