Audit Scotland has published a pretty scary analysis of NHS Scotland today as we hopefully move into the post-pandemic recovery phase. There are four key messages:
1 The NHS in Scotland is operating on an emergency footing and remains under severe pressure. Covid-19 has created a growing backlog of patients waiting much longer for treatment. The backlog poses a significant risk to the Scottish Government’s recovery plans, which aim to transform how care is delivered.
2 NHS and social care workforce planning has never been more important. It must also prioritise addressing workforce availability challenges if its recovery plan is to be successful. Its plans to recruit and retrain staff are ambitious and will be challenging to achieve given the NHS’s historical struggles to recruit enough people with the right skills.
3 The NHS’s ability to plan for recovery from Covid-19 remains hindered by a lack of robust and reliable data across several areas. This includes workforce data, as well as primary, community, social care and health inequality data.
4 The NHS was not financially sustainable before the pandemic and responding to Covid-19 has increased those pressures, and there is uncertainty about future Covid-19 funding levels and the longer-term financial position. The key to financial stability remains a clear focus on the Scottish Government’s long-standing commitment to transform how health and social care services are delivered.
When the auditor says the recovery plan is "ambitious" that ought to be translated to something more like "unlikely to be achieved" or even "unrealistic", and from paragraph 79, "not thought through". A good example is delayed discharges, which have returned to pre-pandemic levels. A clear indication that social care needs immediate action.
1 The NHS in Scotland is operating on an emergency footing and remains under severe pressure. Covid-19 has created a growing backlog of patients waiting much longer for treatment. The backlog poses a significant risk to the Scottish Government’s recovery plans, which aim to transform how care is delivered.
2 NHS and social care workforce planning has never been more important. It must also prioritise addressing workforce availability challenges if its recovery plan is to be successful. Its plans to recruit and retrain staff are ambitious and will be challenging to achieve given the NHS’s historical struggles to recruit enough people with the right skills.
3 The NHS’s ability to plan for recovery from Covid-19 remains hindered by a lack of robust and reliable data across several areas. This includes workforce data, as well as primary, community, social care and health inequality data.
4 The NHS was not financially sustainable before the pandemic and responding to Covid-19 has increased those pressures, and there is uncertainty about future Covid-19 funding levels and the longer-term financial position. The key to financial stability remains a clear focus on the Scottish Government’s long-standing commitment to transform how health and social care services are delivered.
When the auditor says the recovery plan is "ambitious" that ought to be translated to something more like "unlikely to be achieved" or even "unrealistic", and from paragraph 79, "not thought through". A good example is delayed discharges, which have returned to pre-pandemic levels. A clear indication that social care needs immediate action.
Demand for services is rising, while activity levels are still down. That is resulting in long waiting times as this graphic shows.
Rising health inequality is not due to the pandemic, but it hasn't helped. The gap in healthy life expectancy, before chronic conditions set in, is now more than 20 years. The challenge is not just in socio-economic gaps, but on disability and ethnicity. Audit Scotland says: "there are no separate plans for people with disabilities or those experiencing homelessness... The Scottish government should develop an overarching strategy for tackling health inequalities and develop work programmes for all target groups."
On the Recovery Plan, Audit Scotland is sceptical, "The recovery plan will involve new ways of delivering services and these will take a lot of work. There is not enough detail in the plan to determine whether ambitions can be achieved in the timescales set out."
This is particularly true for the workforce. Plans to recruit more staff are not the same as actual workers on the wards or in the community. Staffing plans continue to be hobbled by a "lack of robust and reliable workforce data", and "innovative recruitment methods" will be required to deliver on staff goals. This was also clear pre-pandemic - little has changed.
BMA Scotland summed up the report well, "Today's report also supports the view we have long held - and was clearly the case pre-pandemic - that the NHS in Scotland is financially unsustainable, and that position is worsening," He said there was a "clear danger" that a lack of proper workforce planning would undermine any possible NHS recovery.
Audit Scotland's report is a welcome reminder that glossy documents that set out ambitious plans are not the same as actual delivery. That is what the Scottish Government should be focusing on.
On the Recovery Plan, Audit Scotland is sceptical, "The recovery plan will involve new ways of delivering services and these will take a lot of work. There is not enough detail in the plan to determine whether ambitions can be achieved in the timescales set out."
This is particularly true for the workforce. Plans to recruit more staff are not the same as actual workers on the wards or in the community. Staffing plans continue to be hobbled by a "lack of robust and reliable workforce data", and "innovative recruitment methods" will be required to deliver on staff goals. This was also clear pre-pandemic - little has changed.
BMA Scotland summed up the report well, "Today's report also supports the view we have long held - and was clearly the case pre-pandemic - that the NHS in Scotland is financially unsustainable, and that position is worsening," He said there was a "clear danger" that a lack of proper workforce planning would undermine any possible NHS recovery.
Audit Scotland's report is a welcome reminder that glossy documents that set out ambitious plans are not the same as actual delivery. That is what the Scottish Government should be focusing on.
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