NOT FINANCIALLY SUSTAINABLE
Audit Scotland's latest report reveals a Scottish Health Service on the edge
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THE latest Audit Scotland Report comes amid the horrific scenes emerging from the Russian-Ukrainian war. But here at home our domestic politics does not take a pause, and the latest report from Audit Scotland merits a moment of your attention. Not least as it paints a picture of a national health system nearing the edge of a precipice.
Scotland’s National Health Service (NHS) entered this pandemic in a financial state which was not sustainable. Not my words, the words of Audit Scotland,
“The NHS was not financially sustainable before the pandemic and responding to Covid-19 has increased those pressures.”1
And this should not come as a shock to anyone. This is not a case of hindsight being 20-20. This is not a situation where in hindsight things are obvious that were not obvious from the outset; Audit Scotland has been warning about the NHS’s financial outlook for some time now.
By way of example, prior to the pandemic’s arrival, Audit Scotland’s 2019 report revealed an NHS facing serious financial instability,
“Achieving financial sustainability remains a major challenge for NHS boards. There have been increases in predicted deficits and additional financial support provided by the Scottish Government, and a continued reliance on one-off savings. Capital funding from the Scottish Government has decreased by 63 per cent over the last decade and the level of backlog maintenance remains high, at £914 million. High-profile, newly-built hospitals have come under significant scrutiny because of health and safety concerns.”2
That was in 2019, before the first confirmed Covid-19 case in Scotland on March 1, 2020.
Scotland entered this health pandemic with an NHS facing increasing deficits, a culture of reliance on one-off savings, falling capital funding from Government and major questions surrounding fallout from new build hospitals failing to live up to necessary health and safety needs.
In particular that line in the 2019 Audit Scotland report about “High-profile, newly-built hospitals” is undoubtedly a polite reference to the scandal-hit ‘Queen Elizabeth University Hospital’ (QEUH) here in Glasgow. That is a sorry story of a new hospital planned, approved and built all under this Scottish National Party Government. The QEUH itself has cost £842m, faced delayed opening and has been scandal hit ever since.
News of “serious failings” confessed by the health board, amid scenes where “84 children were infected with rare bacteria while undergoing treatment”3. A new mega-hospital with failing ventilation systems, infections of patients due to tainted water supply, collapsing panelling and patient fungal infections (cryptococcus) caused by pigeon droppings4. The QEUH is a sorry story of how not to manage a project, and one where the Scottish Government continues to get off too lightly. Systemic failures betraying hard working staff, patients and families.
If that was how we entered the pandemic, is it any wonder that today we learn in Audit Scotland’s latest report that
“The NHS was not financially sustainable before the Covid-19 pandemic, with boards relying on additional financial support from government or non-recurring savings to break even. The scale of the financial challenge has been exacerbated by the pandemic. The cost of delivering services has risen and additional spending commitments made by the Scottish Government add to NHS boards’ financial pressures.”5
Two interesting points in that to unpack, regarding “non-recurring savings to break even” and rising costs due to “additional spending commitments made by the Scottish Government”.
I have written before about the extremely negative impacts “non-recurring savings” are were having on the NHS before the pandemic. So rather than repeat myself, I will simply point you to my article exploring exactly this in the specific case of Dumfries & Galloway NHS. That was a story where non-recurring savings were being used to sustain an NHS facing a huge financial gap in its funding - and all prior to a pandemic which has undoubtedly making matters worse.
So given one-off savings were being used in the Scottish NHS to paper over the cracks of serious financial instability, we really ought to ask why the SNP-led government is making additional spending commitments under these circumstances.
One such example is the lunacy of the SNP in bringing forward plans for the NHS to ‘go net zero’.
“The Scottish Government has also now committed to bringing forward its target date for the NHS estate to achieve net zero emissions from 2045 to 2040. This will require substantial investment and it is not yet clear whether additional capital funding will be needed to achieve this over and above the £10 billion already announced.”6
I have no objections to ensuring our NHS is environmentally sustainable, but I really do think ensuring that it is financially sustainable is a more immediate priority. A ‘net zero NHS’ unable to catch a hypothetical cancer diagnosis early enough to prevent my death would not mean much to me, frankly.
Moving the target up from 2045 to 2040 will probably make for a nice line in a speech for Nicola Sturgeon to deliver at a party conference or in a particularly challenging Holyrood debate. But moving up the timetable by five years represents major increases in costs, expenditure and as Audit Scotland makes clear - it is far from clear how much additional capital funding will be needed on top of an already financially substantial environmental commitment for the NHS.
BUT as if that is not alarming enough, remember that the NHS has now to wrestle with the challenge of enormous waiting list backlogs resultant from the pandemic.
The number of people waiting longer than six weeks for diagnostic tests has risen 222.4% between April 2019 and September 2021. Additionally, the number waiting longer than twelve weeks for an inpatient or day case admission is up 178.3% over the same time period. Furthermore the number waiting longer than twelve weeks for a new outpatient appointment rose 155.5%.7
These major spikes in the lengths of waits in our NHS only underscores the sheer scale of the challenge it now faces. And let me tell you, “non-recurring efficiency savings” will not be sufficient to paper over the innumerable cracks in our Scottish health service going forward.
If only we had a Scottish Government and a Health Secretary with something approaching the necessary levels of competence to inspire confidence. Sadly however, all we have is Nicola Sturgeon and Humza Yousaf. I for one, do not hold out much hope.
Audit Scotland (2022, February), ‘NHS in Scotland 2021’, page 3, https://www.audit-scotland.gov.uk/uploads/docs/report/2022/nr_220224_nhs_overview.pdf
Audit Scotland (2019, October), ‘NHS in Scotland 2019’, page 5, https://www.audit-scotland.gov.uk/uploads/docs/report/2019/nr_191024_nhs_overview.pdf
BBC News (2021, March 22), ‘Serious failings' over Glasgow hospital infections’, https://www.bbc.co.uk/news/uk-scotland-56488374
Hall, Tasha (2021, November 18), ‘Timeline of tragedy at the troubled Queen Elizabeth University Hospital’, Scottish Daily Express, https://www.scottishdailyexpress.co.uk/news/scottish-news/timeline-tragedy-troubled-queen-elizabeth-25485954
Audit Scotland (2022, February), ‘NHS in Scotland 2021’, page 37 , https://www.audit-scotland.gov.uk/uploads/docs/report/2022/nr_220224_nhs_overview.pdf
Ibid
Audit Scotland (2022, February), ‘NHS in Scotland 2021’, page 16 , https://www.audit-scotland.gov.uk/uploads/docs/report/2022/nr_220224_nhs_overview.pdf