NHS In Scotland Under Sever Pressure According to Audit Scotland

22nd February 2024

The Scottish Government needs to develop a clear national strategy for health and social care to address the pressures on services.

Significant changes are needed to ensure the financial sustainability of Scotland's health service. Growing demand, operational challenges and increasing costs have added to the financial pressures the NHS was already facing. Its longer-term affordability is at risk without reform.

Activity in hospitals and other secondary care settings has increased in the last year, but it remains below pre-pandemic levels and is being outpaced by demand. This pressure is creating operational challenges throughout the whole system and impacting staff, patient experience and patient safety.

There are a range of strategies, plans and policies in place for the future delivery of healthcare, but no overall vision. The absence of a shared national vision, and a clear strategy to deliver it, makes it more difficult for NHS boards to plan for change.

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."

The overall health and social care budget for 2023/24 was set at
£19.1 billion, representing over one-third of the total Scottish budget and 38 per cent of the discretionary budget, although in-year changes reduced this to £18.9 billion.2 This means, in real terms, there was a small annual reduction in the health budget of 0.2 per cent. However, this relates mainly to increases in the annual transfers of social care funding to the local government portfolio
to support social care and mental health service delivery.

Notes
1. The last vision for health and social care in Scotland was published in 2013. Since then, 21 strategies, plans and policies relating to health and social care have been published.

2. The health budget has been increasing in real terms since 2013/14.

3. Five health boards needed additional funding from the Scottish Government to break-even in 2022/23.

4. Following the 2024/25 budget in December 2023, the Scottish Government told NHS boards that they should pause the development of any projects not yet passed certain development milestones. This includes the six remaining National Treatment Centres.

5. Audit Scotland has prepared this report for the Auditor General for Scotland. All Audit
Scotland reports published since 2000 are available at www.audit-scotland.gov.uk

• The Auditor General appoints auditors to Scotland's central government and NHS bodies; examines how public bodies spend public money; helps them to manage their finances to the highest standards; and checks whether they achieve value for money. The Auditor General is independent and is not subject to the control of the Scottish Government or the Scottish Parliament

• Audit Scotland is a statutory body set up in April 2000, under the Public Finance and Accountability (Scotland) Act 2000. It provides services to the Auditor General for Scotland and the Accounts Commission for Scotland.


Rwad the full Audit Scotland report HERE
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