Health services in the Lothians are underfunded by almost £13 million as the NHS struggles to cope with increasing costs, staff shortages and “unprecedented” savings targets, a new report by Audit Scotland said today.
The ‘NHS in Scotland 2016 ’ report reveals:
- Funding is not keeping pace with increasing demand and patient need
- Only one of the eight key performance targets for the NHS was met in the last year
- A workforce crisis resulting in a huge increase in agency spend - £175 million spent in the last year alone
- A number of consultants making the equivalent of £400,000 per annum
- Health boards facing hundreds of millions of pounds of cuts especially in acute services
- Some health boards underfunded through the SNP Government’s own formula to the tune of tens of millions of pounds
Labour is now calling for an emergency statement from the SNP Health Secretary Shona Robison to outline the government's response to the report.
Labour Health spokesperson Anas Sarwar said:
“Lothian is not getting a fair deal from the NHS, the Health Secretary or the Scottish Government. That is not fair for patients or staff and it needs to be fixed.
"This expert report underlines what Labour has been saying for months - after a decade of SNP mismanagement our NHS is in real distress.
"The scale of mismanagement in our health service revealed by this report is utterly staggering. On every key test the SNP is failing.
"Whilst the SNP government is reviewing standards in the NHS this report reveals that only one out of eight key standards gets pass marks from Audit Scotland.
"Labour has spoken out over the unacceptable pressure staff are under in our NHS - this report reveals that under the SNP the workforce crisis in our NHS is so bad that private consultants can make the equivalent of £400,000 a year in our health service. Last year our NHS was forced to spend £175 million on agency staff making sky high rates.
“Under the SNP nine out of ten nurses are saying their workload is getting worse, one out of four GP surgeries say they are understaffed and only a third of NHS staff believe there are enough of them to do their jobs properly.
“Our NHS staff are the foundations that our most valued public service is built on - if the doctors and nurses are telling us they aren't getting the support they need we should listen.
"The SNP called Labour liars when we said local health services were under threat - this paper confirms that under the SNP, the NHS is facing a cuts bombshell with key services facing the axe.
"SNP Health Secretary Shona Robison must make an emergency statement to parliament. The scale of failure outlined in this report is so large that it demands an immediate response from the SNP government."
The NHS recognises Lothian has been underfunded since 2009 when a new formula was introduced to allocate health spending across Scotland.
It has gradually been reducing the gap between actual funding and the amount Lothian should get. It was meant to have been narrowed to less than one per cent by this year. But Lothian’s funding was still 1.5 per cent – or £18.8m – short, so the board had to get a further £6m to help out.
But the audit report said at July 31, NHS Lothian had overspent against its revenue budget by £7.1m, mainly driven by over-spending on pay and prescribing.
Earlier this month, it was revealed that NHS Lothian had been forced to make a U-turn on its decision to stop sending people to private hospitals for treatment after rocketing demand left more than 14,000 patients languishing on waiting lists.
And earlier this year, a survey found more than two-thirds of NHS Lothian workers felt unable to do their jobs properly due to lack of staff.
Audit Scotland Report, "NHS in Scotland 2016" - Key Quotes
- NHS Scotland key performance targets met at March 2016 - 1 out of 8
- Number of outpatients waiting for an appointment at March 2015: 254,911 and March 2016: 275, 517
- Total savings reported by NHS boards in 2015/16 £291 million - Total savings planned by NHS boards in 2016/17 £492 million
- NHS funding is not keeping pace with increasing demand and the needs of an ageing population.
- Boards are struggling to meet the majority of key national standards and the balance of care, in terms of spending, is still not changing.
- The NHS workforce is ageing and difficulties continue in recruiting and retaining staff in some geographical and specialty areas. Workforce planning is lacking.
- NHS boards’ spending on temporary staff is increasing and this is putting pressure on budgets.
- There is evidence of boards increasingly using short-term approaches to meet the annual financial targets in 2015/16. Some boards only managed to achieve financial balance through one-off measures. In NHS Ayrshire and Arran, the auditors identified a prepayment for the cost of public holidays of over £1 million that was contrary to proper accounting practice. This involved the board moving costs from 2015/16 into 2016/17 to achieve financial balance. The auditor concluded that this was not an acceptable approach by the board to achieve its financial targets and the board corrected the accounting treatment.
- These approaches are unsustainable and make it difficult for boards to plan and invest in longer-term policy aims, such as developing more community-based services and treating people in homely settings.
- The total savings that boards are aiming to make has increased by 65 per cent in real terms, from £293 million in 2015/16 to £484 million in 2016/17 (£492 million in cash terms). This is by far the largest annual percentage increase in the savings target over the last four years.
- A survey of 1,800 GPs in Scotland in 2015, a quarter of GPs described their workload as unmanageable and over two-thirds felt that workload had a negative impact on their personal commitment to their career.
- £23.5 million on agency nursing and midwifery staff, an increase of 47 per cent compared to 2014/15.
- An analysis of the top value invoices by individual agency workers identified a small number of individual consultants being paid over £400,000 to provide cover for periods of less than a year.
- Difficulties in recruiting and retaining staff and greater use of temporary staff may pose risks to patient safety and quality of care.
- Around one in two community nurses were aged 50 and over, compared with one in three hospital nurses in 2015.
- It is not clear what the Scottish Government’s aim of shifting the balance of care looks like and how it will be achieved. But indications of a shift would include reducing A&E attendances, emergency admissions to hospital and delayed discharges from hospital. This will require either reducing acute spending to shift resources into the community, or investing additional resources in the community while maintaining spending on acute services. The NHS cannot continue to do everything within the current resources and needs to slow the rate of growth of hospital demand.