TO say the NHS is under pressure is not new and the financial watchdog Audit Scotland often tells it straight.
The report it has issued today, however, brings together all the problems ailing the service and says they are likely to get worse. It also raises serious questions about whether the course of treatment prescribed by the Scottish Government - the 2020 vision - can be realised.
The words in the Audit Scotland press release are more sober than usual: "NHS boards are finding it increasingly difficult to cope with growing pressures."
While all health boards apparently broke even in the 2013-14 financial year, this is only because four received loans from the Scottish Government.
In fact, the report tells us eight boards have received such "brokerage" in the last five years and seven still have to repay the cash, "reducing the amount they will have available to spend on services" in the near future.
At the same time the accountants have to make larger payments to staff pension schemes, meet the rising cost of new treatments and foot a wage bill estimated to increase by about £30 million a year from next April.
Yet over the next two years, Audit Scotland tells us, the planned health budget will reduce by 0.9 per cent in real terms.
Meanwhile, demand, which is already rising because of the increasing number of frail elderly patients, will continue to climb.
According to the report, the number of people on a waiting list for a new outpatient appointment rose 34 per cent between March 2010 and 2014. However, the number of new outpatients seen during the same period increased 13 per cent. Not surprising, then, that the queue is growing and the Scottish Government targets to treat people within set time frames are not being met.
Audit Scotland acknowledges the considerable effort made by health boards to hit these goals, but says last March only three out of nine waiting times promises were delivered.
No frontline health board met the target for offering those referred to hospital their first outpatient appointment within three months.
Boards are also finding it difficult to give everyone treatment within the Scottish Government's 12-week goal, which has been enshrined in law. Performance against the cancer waiting times and accident and emergency waiting times targets also deteriorated last year.
As for discharging patients when they are well enough to go home - a crucial area when it comes to coping with the growing elderly population - the report says delays have been increasing for five years and rose notably in 2013-14.
It reveals a number of NHS boards carried out snapshot audits reviewing the healthcare needs of all patients in hospital on one day. These found that, for about 25 per cent, there was no clinical reason for them to remain on wards. They were, instead, waiting to be seen by a consultant, assessed by social work or for a care home place to become available.
With difficulties recruiting enough doctors also highlighted, the report paints a picture of the NHS fighting fire at the very time when it needs to change to avoid an inferno.
Two things are missing. One is good insight into the pressures on council social care services. How are their staff coping with the number of NHS patients who need their attention either in hospital or at home and how are their budgets coping with demand?
The other? A detailed plan showing what is needed, as more elderly people require care, to keep the NHS out the quagmire.
Why are you making commenting on The Herald only available to subscribers?
It should have been a safe space for informed debate, somewhere for readers to discuss issues around the biggest stories of the day, but all too often the below the line comments on most websites have become bogged down by off-topic discussions and abuse.
heraldscotland.com is tackling this problem by allowing only subscribers to comment.
We are doing this to improve the experience for our loyal readers and we believe it will reduce the ability of trolls and troublemakers, who occasionally find their way onto our site, to abuse our journalists and readers. We also hope it will help the comments section fulfil its promise as a part of Scotland's conversation with itself.
We are lucky at The Herald. We are read by an informed, educated readership who can add their knowledge and insights to our stories.
That is invaluable.
We are making the subscriber-only change to support our valued readers, who tell us they don't want the site cluttered up with irrelevant comments, untruths and abuse.
In the past, the journalist’s job was to collect and distribute information to the audience. Technology means that readers can shape a discussion. We look forward to hearing from you on heraldscotland.com
Comments & Moderation
Readers’ comments: You are personally liable for the content of any comments you upload to this website, so please act responsibly. We do not pre-moderate or monitor readers’ comments appearing on our websites, but we do post-moderate in response to complaints we receive or otherwise when a potential problem comes to our attention. You can make a complaint by using the ‘report this post’ link . We may then apply our discretion under the user terms to amend or delete comments.
Post moderation is undertaken full-time 9am-6pm on weekdays, and on a part-time basis outwith those hours.
Read the rules hereComments are closed on this article