Squeezed finances of Scottish NHS ‘impacting on services’

27 Aug 19

Health services across Scotland face “significant financial challenges”, with the integration of health and social care adding further complexity, according to analysis.

NHS boards struggling to break even were too reliant on unsustainable one-off savings as financial pressure on the health service continued to intensify, the annual report of the Sharing Intelligence for Health & Care Group released today found.

The financial constraints in which Scotland’s health and social care integration authorities were operating were impacting on strategic planning and commissioning, and on the development and delivery of services, it added.

The group, which was set up in 2014 in response to the scandal at Mid Staffordshire NHS Foundation Trust, draws on intelligence from seven organisations including Audit Scotland, the Care Inspectorate and Healthcare Improvement Scotland to provide an overview of how care systems across Scotland are performing.

It painted a mixed picture on clinical performance, with a significant reduction in the percentage of people referred with a suspicion of cancer beginning treatment within 62 days of referral, and worsening performance against targets on inpatient and outpatient waiting times overall.

However, there was a decline in the hospital mortality rate, improvements in patient safety, and a significant reduction in infant deaths, as well as an “encouraging” drop in the rate of antibiotics prescription in community settings.

It warned that budgetary strain on the NHS would continue to increase, with pressures such as drug costs, a backlog of maintenance, and the use of temporary staff predicted to continue in future years

“While the level of savings achieved by NHS boards is unprecedented, and has involved hard work and innovation, there has also been a heavy reliance on one-off savings,” it said. 

“This reliance on such ‘non-recurring’ savings is unsustainable, because they are becoming increasingly difficult to identify.” 

It also reflected a focus on short-term actions rather than transformational change and long-term financial planning, it said.

There was “more to be done” by Scotland’s 31 integration authorities to deliver new and innovative ways of working across health and social care, the report found.

Lines of accountability for health and social care integration were still blurred in places, and there was a need for greater clarity to avoid duplication in governance arrangements and to allow overspends to be managed. 

However, it said the Scottish Government’s medium-term health and social care financial framework was an important step in enabling an open debate about the challenges ahead, while the move to allow NHS boards to break even over a three year period, rather than at the end of each financial year, would provide greater flexibility.

“On the basis of our work as seven national organisations, we believe that a greater scale and pace of change is required to ensure that people’s health and care needs are met in future,” the report concluded. 

“There needs to be open and honest debate, locally and nationally, about the changes that are needed to sustainably deliver health and care services in Scotland that are of high quality and value, and also to more fully integrate health and social care services.”

The Scottish Government said its medium-term financial framework recognised the challenges facing NHS boards and set out the types of initiatives that were required to deliver balanced and sustainable services.

“As part of our ongoing commitment to supporting frontline services, we are investing more than £14bn in the health budget this year,” a spokesperson said.

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