Comment / Auditors call for faster transformation

The Scottish government has backed Audit Scotland’s call for the NHS to increase the pace of change to new models of service delivery.

In its annual report on NHS Scotland’s performance, the auditor said the service was facing significant pressures. These included rising costs, such as a 4% cash increase in primary and secondary drug costs and changes to employers’ superannuation rates from 13.5% to 14.9%. Investment in the NHS estate was required, with 35% of the estate unsuitable and backlog maintenance of £797m.

Revenue costs for private finance initiative and non-profit-distributing projects will increase by an estimated 38% to £307m by 2027/28 and are due to rise further. And, as in many other parts of the UK, recruitment and retention of permanent staff is a big problem. In 2014/15, boards spent £284m on temporary staff, an increase of 15% on 2013/14. Fundamental change – implemented at a faster pace – was required to deal with these pressures.

The report, NHS in Scotland 2015, commended the service for ending 2014/15 with a £10m underspend and a total spend of £11.4bn. But it added that many health boards needed one-off savings or extra financial support from the Scottish government to break even. Only two of nine key waiting time targets and standards were met, reflecting a recent general decline in performance, it added.

The report set out several recommendations to ensure sound financial and workforce planning underpin future changes. These included giving greater financial flexibility to health boards, allowing them to assess their spending needs over five to 10 years.

Auditor general for Scotland Caroline Gardner warned that without change, the NHS would not be able to provide services as it does at present.

‘We have highlighted concerns around targets and staffing in previous reports,’ she said. ‘These have intensified over the past year, as has the urgency for fundamental changes such as introducing new ways to deliver healthcare and developing a national approach to workforce planning. It is important that the Scottish government and health boards work closely together to help alleviate these pressures and also increase the pace of change necessary to meet its longer-term ambitions.’

Scotland health secretary Shona Robison said her government had protected frontline health spending and the service was performing well.

‘These are strong foundations on which to build. However, I agree with Audit Scotland that we need to up the pace of change on our 2020 vision to provide more care in the community,’ she said.