Scottish NHS performance 'continuing to decline'
- Published
The NHS in Scotland is not financially sustainable and its performance has continued to decline, the public spending watchdog has warned.
Audit Scotland said health boards were "struggling to break even" and none had met all of the key national targets - with NHS Lothian not meeting any.
It highlighted increasing demand on NHS services, and rising waiting lists.
Health Secretary Jeane Freeman said the government was already taking forward Audit Scotland's recommendations.
But the watchdog's report prompted widespread criticism of the Scottish government, with the Conservatives claiming it should "make shameful reading for the SNP".
The report said pressure is building in several areas - including the recruitment and retention of staff, rising drug costs, Brexit and a significant maintenance backlog.
It said "decisive action" was needed to protect the "vital and valued service".
What does the report say?
The report warned that the NHS in Scotland is "not in a financially sustainable position", with NHS boards "struggling to break even, relying increasingly on Scottish government loans and one-off savings".
And it said the "declining performance against national standards indicates the stress NHS boards are under".
The only target met nationally in 2017/18 was for drugs and patients to be seen within three weeks.
Only three of Scotland's regional health boards met the target for patients beginning cancer treatment within 62 days of being referred
The Scottish government admitted earlier this year that children were being "let down" by the country's mental health services
Performance against each of the eight national targets fell, with the the greatest drop in Child and Adolescent Mental Health Services (CAMHS).
The proportion of youngsters seen by CAMHS within 18 weeks fell from 83.6% in 2016/17 to 71.2% in 2017/18.
The Scottish government invested £13.1bn in NHS services last year, but Audit Scotland said when inflation was taken into account there was a 0.2% real terms drop in cash.
Health boards made "unprecedented" savings of £449.1m, but many relied heavily on one-off savings for this, while three boards - NHS Ayrshire and Arran, NHS Highland and NHS Tayside - needed £50.7 million of loan funding from the government to break even.
This was "significantly more" than in previous years, with Audit Scotland saying four boards have predicted they will need a combined total of £70.9m in this current financial year.
Jeane Freeman announced a three-year plan to cut NHS waiting times earlier this week
The report said the "NHS is managing to maintain the overall quality of care, but it is coming under increasing pressure", adding Brexit would create "additional challenges" for the health service.
However the scale of these challenges was "difficult to assess" because of "significant uncertainty" over the terms of the UK's withdrawal deal from the European Union, and because data on workforce nationality is not routinely collected.
Auditor General Caroline Gardner said: "The performance of the NHS continues to decline, while demands on the service from Scotland's ageing population are growing.
"The solutions lie in changing how healthcare is accessed and delivered, but progress is too slow."
What has the Scottish government said in response?
Health Secretary Jeane Freeman said the government was already taking forward Audit Scotland's recommendations.
She said NHS funding had reached "record levels of more than £13bn this year, supporting substantial increases in frontline NHS staffing, as well as increases in patient satisfaction, reductions in mortality rates, falls in healthcare associated infections, and Scotland's A&E performance has been the best across the UK for more than three years."
She added: "While our NHS faces challenges, common with health systems across the world, we are implementing a new waiting times improvement plan to direct £850m of investment over the next three years to deliver substantial and sustainable improvements to performance, and significantly improve the experience of patients waiting to be seen or treated.
"Ultimately we want to ensure people can continue to look forward to a healthier future with access to a health and social care system that continues to deliver the world-class compassionate care Scotland is known for."
What other reaction has there been?
Conservative health spokesman Miles Briggs claimed the NHS was "facing an unprecedented challenge" with boards across the country "staring into a black hole of more than £130m.
He said: "For a government which has been in charge for more than 11 years, this should make shameful reading for the SNP."
Labour's Monica Lennon added: "After more than a decade of SNP complacency our NHS is in crisis."
Dr Lewis Morrison, chairman of the British Medical Association (BMA) in Scotland, said the "stark warning" from Audit Scotland "could not be any blunter".
But he added this would "come as no surprise to frontline doctors who have faced the consequences of inadequate funding year after year".
And RCN Scotland director Theresa Fyffe said the report "underlines what those in the nursing profession have been warning about for a number of years - an unsustainable pressure on staff to deliver more care.
"This leads to staff burnout and, in some cases, a choice between staying in the profession and their own health."