The NHS in Scotland is not financially sustainable and its performance has continued to decline, Scotland’s public spending watchdog warned.
A new Audit Scotland report found health boards were “struggling to break even” and said no part of the country had met all of the key national targets for the service – with NHS Lothian failing to achieve any of the eight.
With increasing pressure on NHS services, and rising numbers of people on waiting lists, Auditor General Caroline Gardner said “decisive action” was now needed from ministers to secure the future of the “vital and valued service”.
She stated: “The performance of the NHS continues to decline, while demands on the service from Scotland’s ageing population are growing.
“The solutions lie in changing how healthcare is accessed and delivered, but progress is too slow.”
The NHS in Scotland is not in a financially sustainable position
The report prompted widespread criticism of the Scottish Government, with Conservative health spokesman Miles Briggs claiming the NHS was “facing an unprecedented challenge” with boards across the country “staring into a black hole of more than £130 million”.
He said: “For a government which has been in charge for more than 11 years, this should make shameful reading for the SNP.”
Labour’s Monica Lennon added: “After more than a decade of SNP complacency our NHS is in crisis.”
They spoke out after the Audit Scotland report warned: “The NHS in Scotland is not in a financially sustainable position.”
It added “NHS boards are struggling to break even, relying increasingly on Scottish Government loans and one-off savings”, and the “declining performance against national standards indicates the stress NHS boards are under”.
The only target met nationally in 2017-18 was for drugs and patients to be seen within three weeks, with only three of Scotland’s regional health boards meeting the target for patients beginning cancer treatment within 62 days of being referred.
While performance against each of the eight national targets fell the greatest drop was in Child and Adolescent Mental Health Services (CAMHS), with the proportion of youngsters seen within 18 weeks down from 83.6% in 2016-17 to 71.2% in 2017-18.
The Scottish Government invested £13.1 billion in NHS services last year, but Audit Scotland said when inflation was taken into account there was a 0.2% real terms drop in cash.
Health boards made “unprecedented” savings of £449.1 million, but many relied heavily on one-off savings for this, while three boards – NHS Ayrshire and Arran, NHS Highland and NHS Tayside – needed £50.7 million of loan funding from the Government to break even.
This was “significantly more” than in previous years, with Audit Scotland adding four boards have predicted they will need a combined total of £70.9 million in this current financial year.
The report said the “NHS is managing to maintain the overall quality of care, but it is coming under increasing pressure”, adding Brexit would create “additional challenges” for the health service.
However the scale of these was “difficult to assess” because of “significant uncertainty” over the terms of the UK’s withdrawal deal from the European Union, and because data on workforce nationality is not routinely collected.
Dr Lewis Morrison, the chair of the British Medical Association (BMA) in Scotland, said the “stark warning” from Audit Scotland “could not be any blunter”.
But he added this would “come as no surprise to frontline doctors who have faced the consequences of inadequate funding year after year”.
Dr Morrison stated: “Funding in the NHS is simply not keeping pace with demand and that has pushed NHS services across the country into the parlous position this report details.
“Meanwhile medical vacancies are adding significantly to the difficulties we face and not enough is being done to attract or retain doctors working in Scotland. The report is clear that workforce planning is still inadequate and the Scottish Government need to tackle this urgently.
“There simply must be concerted action taken to address recruitment and retention issues for doctors, and indeed all staff, to ensure that working in Scotland’s NHS is an attractive career choice.”
Health Secretary Jeane Freeman said the government was already taking forward Audit Scotland’s recommendations.
She stated: “Under this Government, NHS funding has reached record levels of more than £13 billion this year, supporting substantial increases in frontline NHS staffing, as well as increases in patient satisfaction, reductions in mortality rates, falls in healthcare associated infections, and Scotland’s A&E performance has been the best across the UK for more than three years.
“While our NHS faces challenges, common with health systems across the world, we are implementing a new waiting times improvement plan to direct £850 million of investment over the next three years to deliver substantial and sustainable improvements to performance, and significantly improve the experience of patients waiting to be seen or treated.
“Ultimately we want to ensure people can continue to look forward to a healthier future with access to a health and social care system that continues to deliver the world-class compassionate care Scotland is known for.”