‘Significant changes’ needed to Scottish health service

The auditor general’s NHS Scotland 2023 report warned that “significant changes” were required to ensure the financial sustainability of Scotland’s health service.

“Our members tell us that unacceptable and unsafe working conditions are being normalised”

Colin Poolman

It called on the Scottish Government to provide a clear national strategy for health and social care including investment in preventative measures, with patients at the centre of future services.

The report also found that NHS staff remained under significant pressure, and that it was “not clear” that the current workforce strategy and other ongoing actions were enough to meet this challenge.

It recommended that the Scottish Government should this year publish an update to the national workforce strategy for health and social care, and that this should include guidance on improving staff wellbeing and culture and data on projected workforce growth.

Last year’s Audit Scotland report found that workforce capacity remained “the biggest risk” to the recovery of NHS services in Scotland.

Since then, several programmes have been launched in Scotland with the aim of improving staff wellbeing as well as recruitment and retention of NHS staff.

These have included the establishment of a Nursing and Midwifery Taskforce which was announced in February 2023, and the commissioning of a National Centre for Remote and Rural Health and Care to help address concerns over the recruitment and retention of staff in remote and rural areas.

But the current audit suggested that despite these programmes, current workforce levels were not high enough to meet demand.

The report also stated that the workforce challenges in health and social care in Scotland were continuing to have a direct impact on patient safety.

Royal College of Nursing Scotland director Colin Poolman said that this report painted a “worrying picture” of the sustainability of the NHS in Scotland and agreed that an update to the national workforce strategy was needed.

“Our members tell us that unacceptable and unsafe working conditions are being normalised, nursing staff are burnt out and the impact of not being able to provide the level of care they want is taking a serious toll,” he said.

He said that the RCN agreed with Audit Scotland’s call for an overall vision that coordinates action across health and social care.

He added that the report highlighted poor skill mix and high use of agency nurses as specific workforce concerns and said that barriers identified for staff to raise concerns needed to be addressed as part of implementation of Scotland’s safe staffing legislation in April.

“The updated national workforce strategy must be more rigorous than the previous version, with proper workforce planning, based on current and future demand, to ensure Scotland’s health and care services have the right numbers of staff with the right skills.” Mr Poolman said.

“Scotland simply doesn’t have enough nursing staff and the Nursing and Midwifery Taskforce, led by the cabinet secretary, has been set up to address this,” he said.

Colin Poolman

“The situation is desperate, and the Scottish Government must provide the investment, and the political will, needed to ensure the taskforce delivers meaningful change that tackles the nursing recruitment and retention crisis and delivers a sustainable nursing workforce into the future.”

The auditor general for Scotland Stephen Boyle, who wrote the report, said that without change, there was a risk Scotland’s NHS would take up an ever-growing chunk of the Scottish budget, leaving less money for other vital public services.

“To deliver effective reform the Scottish Government needs to lead on the development of a clear national strategy for health and social care,” he said.

Mr Boyle added that this should include investment in measures that address the causes of ill-health, which would reduce long-term demand on the NHS.

Commenting on the audit report, cabinet secretary for NHS recovery, health and social care in Scottland, Neil Gray, said that he welcomed the report and that the Scottish Government would consider the recommendations outlined.

“I am pleased to see Audit Scotland recognise the growth in funding for health and social care, the draft 2024-25 Scottish budget provides over £19.5bn for health and social care,” Mr Gray said.

“Although challenges and difficult decisions remain, this has given our NHS a real-terms uplift in the face of UK Government austerity,” he added.

“Overall, I welcome Audit Scotland’s report and the Scottish Government will consider the recommendations outline.”

He added that the Scottish Government was already taking forward a range of immediate and longer-term reforms to the NHS, and that a vision for further reform would be laid out in the coming weeks.

“The fundamentals of Scotland’s NHS will not change; we remain committed to free access to healthcare,” he said.

“Our workforce is at the heart of services that respond to changing demand. As such, we must deliver a sustainable, skilled workforce with attractive career choices and fair work, who are respected and valued for what they do.

“The NHS workforce is at record levels, and through meaningful engagement with trade unions and employers, we have secured pay agreements with both junior doctors and Agenda for Change staff, meaning we remain the only part of the UK to have avoided industrial action.

“Innovation also remains key in our efforts to meet demand and increase capacity and we recognise prevention is crucial in addressing the causes of ill health.”