Fundamental change needed for health

95.2 per cent A&E departments admitted, transferred and discharged within four hours.
95.2 per cent A&E departments admitted, transferred and discharged within four hours.

The government’s own financial watchdog has called for fundamental changes to the NHS and healthcare delivery.

Audit Scotland warns that changes are needed to ensure the NHS is able to continue providing high-quality services in the future, against a background of missed targets by the health service.

“NHS in Scotland 2015” records a steady decline in performance against seven of nine key targets and standards

The watchdog highlights one of the targets missed – the number of outpatients waiting more than 12 weeks for their first appointment increased from three per cent in March 2013 to eight per cent in March 2015. Of those waiting, five per cent waited for more than 16 weeks.

The report looks at the annual performance of the NHS and its future plans. It says that tightening budgets, rising costs, higher demand for services, demanding targets and standards, and increasing staff vacancies are placing significant pressure on the service.

The report also highlights a £10 million underspend by Scottish health boards in 2014/15, along with significant funding boosts for health boards from the Scottish Government.

Auditor General for Scotland Caroline Gardner said: “We all depend on the NHS and its staff who provide high-quality care. But it will not be able to provide services as it does at present due to the number of pressures it faces within the current challenging financial environment.

“We have highlighted concerns around targets and staffing in previous reports. 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.”

But health secretary Shona Robison defended the Scottish Government’s record on health: “Scotland’s NHS is now performing better against tougher targets, and as Audit Scotland highlights, we have a record high workforce and the level and quality of care provided to patients has contributed to people living longer along with continued advances in diagnosis, treatment and care.”

And she promised: “The Scottish Government has a clear vision for the future of our NHS and we will continue to take the right action to ensure that Scotland continues to have an NHS that it can be proud of today and in the future. We want to ensure that communities get the services they need, delivered by the appropriate range of health and social care professionals working together more effectively.

“We are carrying out far-reaching reforms to our health service, and we continue to consult on how these can be further developed.”

Royal College of Nursing (RCN) Scotland Associate Director Ellen Hudson was quick to respond to the report: “We need to find new ways for health boards to focus on the long-term sustainability of services; although the government has set up lots of reviews and task groups to change how services are delivered in the future, they’re not joined up and risk competing for limited resources.

“If we are to put the NHS on a sustainable footing, then the Government needs to take heed of the recommendations in this report and listen to what we and many other organisations have been saying for some time about the pressures on our health services. And it really needs to step up the pace and bring a much more joined-up approach to support long-term change.”

Scottish Liberal Democrat health spokesman Jim Hume described Scotland’s NHS as: “in need of intensive care. The findings of this latest report are stark: unless SNP Ministers get a grip, the 2020 vision will not be achieved.

“Staff and patients must not be left to pay the price of the SNP’s failure to support health services,” he continued, “Complacency is not an option for SNP Ministers. We need to know what steps they will take to address the huge challenges facing our health service.”

Chair of BMA Scotland Dr Peter Bennie also called for action from the Scottish Government: “The overriding message that must get through from this report is that substantive and realistic action is needed if our health service is to cope with the rapidly increasing pressures it is facing.

“These challenges must be tackled now if patients are to continue to receive the level of care that they need in years ahead.”