NHS faces significant pressures managing finances, meeting targets and making changes to services
The NHS in Scotland is facing significant pressures from increasing demand for services, while also striving to achieve challenging performance targets and working within tightening budgets.
NHS in Scotland 2013/14, published today by Audit Scotland, reports on the performance of the health service and its plans for meeting future needs. It says that NHS boards are finding it increasingly difficult to cope with growing pressures, which will considerably test their ability to deliver a national policy to move more services into the community by 2020.
All health boards met their financial targets in 2013/14, but several needed additional funding from the Scottish Government or relied on non-recurring savings. NHS boards’ revenue budgets increased by just over one per cent in real terms in 2013/14, and smaller real terms increases are planned from 2014/15 onwards.
The report notes that demand for services is rising due to demographic changes, particularly the increasing ageing population of Scotland, the number of people with long-term health conditions and people's expectation of healthcare. Despite substantial efforts, the NHS did not meet some key waiting time targets in 2013/14. Increasing numbers of people being admitted to hospital from A&E, rising numbers of delayed discharges and more demand for outpatient appointments are adding further pressures on services by creating blockages in the system.
The Auditor General for Scotland, Caroline Gardner, said:
"Pressures on services and finances in the health service have been building steadily in recent years. Audit Scotland has previously reported on this increasing strain, and emphasised the need for a focus on long-term financial planning.
"NHS boards need to deliver major changes to meet the future needs of patients. The effort invested in meeting annual targets, within tightening budgets, makes it difficult for NHS boards to reshape care in line with an ambitious national policy. The Scottish Government should review whether the current financial and performance targets for the NHS can be achieved at the same time as implementing its vision for health and social care."
The report recognises that the NHS has made good progress in improving outcomes for people with cancer or heart disease, and reducing healthcare associated infections. The Scottish Government has also developed a number of initiatives to move more services into the community. However, progress has been slow and further significant change is needed.
