Doctors have called for a realistic debate on the future of the NHS in Scotland following a stark warning from auditors.
In its annual review of the financial health and performance of the NHS in Scotland, watchdog Audit Scotland warns that NHS boards are finding it difficult to balance demand for hospital care with investing in community services to meet future need.
It says that health managers will have to make unprecedented levels of savings in the current financial year – and that there is a risk some won’t be able to balance the books.
The NHS in Scotland failed to meet seven out of eight performance targets, the report says, adding that change is needed to make the service fit for the future.
In particular, Audit Scotland warns that action is needed on workforce planning for new models of care in the community – and says the service is already facing challenges in recruitment and retention.
‘The Scottish Government has had a policy to shift the balance of care for over a decade but despite multiple strategies for reform, NHS funding has not changed course,’ said auditor general Caroline Gardner.
‘Before that shift can occur, there needs to be a clear and detailed plan for change, setting out what the future of the NHS looks like, what it will cost to deliver and the workforce numbers and skills needed to make it a reality.’
Close the gap
BMA Scotland national director Jill Vickerman said the report echoed many of the BMA concerns.
‘We have called on politicians to address the urgent need to close the growing gap between constrained resources and rising demand faced by the NHS in Scotland.
‘The challenges around recruiting and retaining doctors further adds to the burden on our health service and action is needed now to address these vacancies which are a feature of consultant, GP, trainee and specialist posts.’
She said more needed to be done to make NHS Scotland a more attractive place to work and that significant reforms were needed to deliver a sustainable health service.
Health secretary Shona Robison said the NHS in Scotland had its highest budget and highest level of staff ever. But she acknowledged: ‘Preparing the NHS for the challenges of the future is not just about additional funding, but also new ways of delivering services.
‘That is why we have invested a quarter of a billion pounds in social care this year as part of our integration policy, and recently committed to an extra £500m to shift the balance towards primary care services before the end of this parliament.’
Ms Vickerman added: ‘Audit Scotland are right to highlight that significant reforms are necessary to deliver a sustainable health service for Scotland.
‘That includes delivering a clear plan for the implementation of the 2020 Vision and National Clinical Strategy, the review of national targets to improve outcomes for patients, an effective workforce strategy and the need to have an honest conversation with the public on how they access and use services and the need for change to protect and enhance the delivery of our health services for the future.’
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