Transforming health and social care in Scotland

Audit Scotland supports the improvement of public services by looking at how public money is spent, and whether policies are achieving desired outcomes for individuals and bodies. We carry out extensive work on Scotland’s health and social care services, which face challenges from reducing budgets, increasing demand, and an ageing population.

We also report on the financial performance of health and social care integration authorities and NHS Bodies, such as health boards, on behalf of the Auditor General and the Accounts Commission.

The page below sets out more information on our work in this important area.

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What's on this page

 

Key facts

  • £19.1 billion spent on Health in 2023/24 40% of the Scottish budget
  • One in 25 people in Scotland receive social care
  • 95.5% of people diagnosed with cancer begin treatment within 31 days of the decision to treat
  • 19% increase in the cost of providing homecare per hour between 2016/17 and 2022/23
  • 2,000 beds per day on average were occupied by delayed discharges by August 2024
  • 87% of unpaid carers said their mental health and wellbeing had been affected by their caring role
  • A £1.1 billion

    decrease in funding to IJB in real terms to £11 billion in 2022/23.

  • 18.4% rise in NHS staff costs in the past 5 years to £10.6 billion
  • 80% of IJBs face financial sustainability risks (2022/23 audits)
  • 69.1% of people attending A&E are admitted, discharged or transferred for treatment within 4 hours
  • 50% of patients are provided with advanced booking to GP practice (3 or more working days in advance) compared to 77% in 2013/14
  • 65% of people referred for a new hospital outpatient appointment are seen within 12 weeks

Publications

Exhibits

The following exhibits are taken from our NHS in Scotland 2024: Finance and performance and Integration Joint Boards' Finance and performance 2024 reports.

Exhibit 1
Exhibit 1
Exhibit 2
Exhibit 2
Exhibit 5
Exhibit 5
Exhibit 6
Exhibit 6

The Public Bodies (Joint Working) (Scotland) Act 2014 (the Act) requires the 32 Scottish councils and 14 territorial NHS boards to work together in partnerships to integrate how social care and community healthcare services are provided. IJBs were created as part of the Act as separate legal bodies. This exhibit sets out how these IJBs operate.

Health remains the single biggest area of government spending, at £19.1 billion in 2023/24. This exhibit shows the high level breakdown of how this funding is distributed. Most health funding is provided directly to territorial boards to carry out their functions and deliver services.

This exhibit summarises the cost pressures faced by NHS boards and the change in net expenditure on these in the last year and over five years.

This exhibit shows the variation across the IJBs in the identified funding gap for 2023/24. All IJBs reported an increase in their projected funding gap with the exception of Orkney IJB. Funding gaps, as a proportion of the 2022/23 net cost of services, ranged from one to ten per cent.

Resources

Video transcript - RTF 15.65 KB 

Integration Joint Boards' Finance and performance 2024

In the video, Angela Leitch, Accounts Commission member talks about the Accounts Commission’s Integration Joint Boards' Finance and performance 2024 briefing. In addition to the briefing we also published three supplements.

  • Supplement 1: Core suite of integration indicators. The Public Bodies (Joint Working) (Scotland) Act 2014 created a legislative requirement for IJBs to report on their performance against a suite of core integration indicators. This supplement summarises, performance against these by each IJB.
  • Supplement 2: IJB members question supplement. This tool is designed to provide IJB members with examples of questions they may wish to use to consider their IJB’s financial and performance position. The questions relate to points raised in the briefing.
  • Supplement 3: Roundtable. This supplement is a summary of issues and messages captured from a roundtable discussion held 15 February 2024. The aim of the roundtable was to hear from a range of people, in strategic roles, from across the sector about the issues currently affecting social services in Scotland.

Annual audits of councils and health bodies

Audit Scotland annually reviews the financial performance and processes of more than 200 public bodies. The Auditor General may also prepare a Section 22 report for the Parliament if any specific concerns or issues have been raised in the audit of a public body. Find out about the performance of health and social care organisations in your local area.

Get in touch

To discuss Audit Scotland’s work on health and social care or let us know what you think about this page, please contact:

Kathrine Sibbald, Senior Manager
ksibbald@audit-scotland.gov.uk

Leigh Johnston, Senior Manager
ljohnston@audit-scotland.gov.uk