In its annual review of the NHS, published today, Audit Scotland highlighted good levels of staff commitment and patient satisfaction but flagged some significant challenges.
Among these are that more people are waiting longer to be seen, the majority of national performance targets have not been met and significant health inequalities persist.
Last year, the health budget in Scotland was £12.9bn, representing 43% of the Scottish Government budget.
While funding has increased, so are operating costs and NHS boards had to make “unprecedented” savings of £390m in order to break even, Audit Scotland said.
Spending more money, however, would not be a sufficient response, the watchdog said.
Rather, a “step change” is needed across the whole system.
Auditor general Caroline Gardner said: “The NHS in Scotland marks its 70th anniversary next year, and there is widespread agreement that healthcare must be delivered differently if it is to withstand growing pressure on services.
“There is no simple solution, but these fundamental areas must be addressed if reform is to deliver the scale of transformation that’s needed across the NHS. “Involving staff, the public and bodies across the public sector will also be crucial for success.”
Audit Scotland said it was “still not clear” how shifting more services from hospitals to the community would be funded and what future funding levels would be required. It suggested clear and long-term plans were needed to set out how funding will be used differently to change services.
The views of staff should also be captured to inform a workforce planning strategy, while capital investment plans should be developed to ensure the NHS can deliver more community-based services.
The Scottish Conservatives said it reflected how badly the SNP government had managed the NHS over the past 10 years.
Health spokesman Miles Briggs said: “Hospitals are short-staffed, workers are stressed and the maintenance backlog is spiralling out of control.
“And while this happens, as this report states, people aren’t getting any healthier.”
Scottish health minister Shona Robison said the administration had “long been realistic” about the challenges facing the NHS in Scotland and the need for change.
She highlighted work under way to integrate health and social care systems and progress on a medium-term financial framework.
“This will be to outline the broad direction for the NHS and care services to meet the changing needs of the people of Scotland, including shifting the balance of care towards community health services,” Robison said.
