NHS in Scotland 2017 – October 26th 2017
Podcast transcript
I am joined today by Kirsty Whyte and Corrinne Forsyth from the Audit Scotland team behind our new report on the NHS in Scotland.  Kirsty and Corrine, thank you for joining me.  
Your report flags up that the NHS in Scotland will be 70 years old next year.  How has the landscape for the health service changed in that time?
Kirsty Whyte: Since the NHS was set up in 1948 both Scotland and its health service have changed significantly.  The Scottish population has grown, and in 2016 reached its highest level ever at 5.4 million people.
The health of the Scottish population has changed considerably over the past 70 years, for example life expectancy has improved.  When the NHS was set up, men lived on average to 64 and women to 69, now life expectancy for men is 77 and for women its 81.  In the early days of the NHS TB was a major cause of death, now it is heart disease and cancer. Similarly a majority of the Scottish population smoked when the NHS was set up, but now it’s a minority.  
The NHS has also changed since it was established. Staff numbers have continued to increase and reached their highest ever level last year. There has been an increase in the number and the range of services provided as technology has improved and demand from the Scottish public has increased.   
It’s important that the NHS keeps evolving to meet the needs of the population and withstand the pressures facing the service, for example an ageing population means more complex care needs.  Significant health inequality still exists in Scotland and pressure on public finances is likely to continue in the foreseeable future.
Right, so we are talking about a dramatically different landscape to when the NHS was first introduced 70 years ago.  Audit Scotland reviews the performance of the health service every year and as you’ve said, Kirsty, there are a number of different challenges that the NHS is experiencing at the moment.  This latest report sets out some of the significant issues that the NHS is dealing with as it enters its eighth decade.  Can you set out what these are for me?
Kirsty Whyte: Our report this year examines the keys issues facing the NHS in 2016/17 and how well it is adapting for the future.  We found that there is significant activity underway to achieve the Scottish Government’s vision that everyone should live longer, healthier lives at home.   But crucial building blocks still need to be put in place if health care in Scotland is to be transformed.  
As we have reported in previous years, the NHS faces a range of challenges and in 2016/17 these continued to intensify.  NHS boards had to make unprecedented levels of savings to break even at £387 million, and they are finding it harder to make these savings.  Cost pressures keep increasing, spending on drugs rose by 7% in the past year, backlog maintenance remains high at £887 million, and spending on agency medical locums also increased by 6% in the past year.   
Demand for services from the Scottish public shows no signs of slowing down and continued to increase over the past year. We found this year that there are warning signs that the NHS’s ability to maintain quality of care is under pressure. In terms of the Scottish population, significant health inequality still exists for those people living in the most deprived communities in Scotland. They are still likely to spend more years in ill-health and die sooner than those people living in the least deprived areas.  
We found that actions are needed as a priority in several key areas if meaningful change is to happen.  The Scottish Government needs to set out how existing and future funding will be used differently to move more healthcare into the community.  Workforce planning needs to improve, and the public and staff need to be better involved in understanding the challenges facing the NHS, the need for the change and then developing options for delivering services differently. 
It’s fair to say that the report covers a large amount of ground then. That’s a lot to think about. As all of us will use the NHS at some point in our lives, and thousands of people work in the health service,   What impact will all of these challenges have on the experiences of patients and staff?
Kirsty Whyte: NHS staff remain committed to providing high quality care, and patient satisfaction with the NHS is at an all-time high.  But this year we have found that there are warning signs that the NHS’s ability to maintain that high quality of care is under pressure.  Patients are now waiting longer to be seen.  There was a 99 % increase in the number of people waiting over 12 weeks for their first outpatient appointment in the last year, and patient complaints have also increased by over 41% in the past 5 years. Some of that is related to the length of time people are now waiting, and a number of different surveys in the past year have found that staff are worried about the quality of care they can provide.  For example, a 2017 Royal College of Nursing staff survey found that over half of respondents felt that patient care was compromised in their last shift due to a lack of staff. A survey of GPs by the British Medical Association found that more than nine out of ten GPs felt their workload has negatively impacted on the quality of care that they can provide.  
It is essential that staff and the public understand the challenges facing the NHS and the need for change, and that they are involved in designing and then agreeing new ways to provide services.  We have recommended in our report that the Scottish Government, NHS boards and integration authorities continue to work with staff and the public to do this.
Given the challenges that are set out in today’s report, it’s tempting to focus on what isn’t working.  But it’s important to point out that you have also identified strengths that the NHS can build on.  What are the positives here?
Kirsty Whyte: There are a number of positives on which the Scottish Government, NHS boards and integration authorities can build on as they try and change how health care is provided in Scotland.  For example, there is widespread agreement on the need for change and on the Scottish Government’s vision that everyone should live longer, healthier lives at home.  
There is also widespread public goodwill towards the NHS.  Patient satisfaction is high and the general public continues to hold the NHS in high regard, and there are early signs that changes are beginning to have a positive impact.  Work to put patients at the centre of their care is being rolled out, and in some areas, changes in how services are being delivered in the community are helping to keep people in their homes for longer and helping them to  manage their own long term conditions.   
So it’s clearly a bit of a mixed picture and there is a lot of work still to be done, but you have made recommendations to support the Scottish Government and others making progress, and set out a few key areas earlier for us where they need to take action.  What does Audit Scotland see as the priorities here? 
Corrinne Forsyth: As Kirsty set out, there are a number of challenges facing the NHS at the moment. One key area is the Scottish Government’s vision for everyone to live longer, healthier lives at home but we don’t  know how much this is going to cost or how it will be funded.  In our report we recommend that the Scottish Government sets out a financial framework for moving more health care into the community and is clear about how much funding will be available in the future years. 
Kirsty Whyte: Another fundamental area that needs addressed is for the Scottish Government and NHS boards to improve their workforce planning.  We published the first of two reports in July 2017 looking at the hospital workforce in Scotland and we made a number of recommendations in that report.  One of the key recommendations was that NHS Boards need to develop a comprehensive approach to workforce planning.  That includes forecasting how many staff they are going to need, what types of staff they are going to need and how much that will cost.  We have also recommended that the Scottish Government needs to improve its national approach to workforce planning to ensure the staff required for the future are in the right places, in the right numbers and at the right time.
It’s a good point that you make, Kirsty, that this isn’t a report that’s aimed just at NHS boards or the Scottish Government.  Bodies right across the public sector need to be involved in reshaping health and social care services for the future. 
Kirsty Whyte: That’s correct.
 And this report is part of a wider programme of work that Audit Scotland carries out on health and social care services.  What will you be looking at next?
We are working on three reports in the next year or so.  We have a report on child and adolescent mental health services; we have just started work on our second report in our three part series in health and social care integration, and we are also planning a second report on workforce planning focusing on primary care. 
A lot to look out for in the future then. You can find today’s report and updates on our future publications on our website at audit-scotland.gov.uk.  
Thank you to Kirsty and Corrine for their time today.