Full transparency needed on Scottish recovery progress

The audit body also called for the government to be clearer about how long it will take to recover from the Covid-19 pandemic and to reform services.

NHS in Scotland 2022 said the country’s health services faced ‘unprecedented’ challenges and the government would need to make difficult choices and prioritise which ambitions it could deliver against. Despite a general trend of growth in health spending, the service faced growing financial pressures from inflation, pay, ongoing Covid costs, rising energy bills, capital maintenance, and the need to fund the National Care Service. These pressures could limit investment in recovery and reform.

‘Money is tight but investment is needed in recovery,’ said Stephen Boyle (pictured), auditor general for Scotland. ‘That means ministers have to prioritise which NHS aims can realistically be delivered. And they need to be more transparent about the progress they're making.

‘The Scottish government has set out the big challenges facing the NHS. But it also needs to clearly explain to the public what those challenges mean for the level of service they can expect, including waiting times,’ he added.

The government published a recovery plan in 2021, but the audit body said it was a ‘high-level, top down’ document that did not contain detailed actions that would allow progress to be measured. And in the meantime, the care backlog had continued to grow, with people joining the waiting list faster than they are being removed from it. Delays in opening three new national treatment centres and shortage of social care capacity were key challenges.

However, workforce capacity remains the biggest risk to the recovery. ‘The NHS recovery plan was not informed by robust modelling and there is a risk workforce targets will not be achieved,’ the report said. High vacancy and turnover rates, compounded by higher than usual sickness absence, were a major part of the problems.

Some progress had been made on recruitment targets – increasing support for general practices from multi-disciplinary teams in the community and training additional advance nurse practitioners, for example. But other targets were not on track. The government has set a target of increasing the GP workforce by 800 by 2027/28. But between 2017 and 2022, GP numbers increased by only 113. And a target to recruit 1,000 additional mental health staff in primary care was also described as ‘at risk’.

The report highlighted substantial increases in inflation in the last two years – from 0.6% in December 2020 to 10.5% in December 2022 – as a significant pressure, increasing costs on everything from food to medicines. NHS pay rises – still not resolved – were also adding to financial uncertainty. The National Care Service will also place a huge strain on the health and social care budget with costs potentially rising beyond the estimated range of between £644m and £1.26bn.

The Scottish government is currently working on its overall revised medium-term financial framework (MTFF). And the audit body said that a similar framework for health and social care should be aligned with this and published ‘as soon as possible after the MTFS is published in May 2023’.