SCOTLAND’s second largest health board has forecast a £43m black hole next year amid growing concerns about the quality of service provided to patients.

Board papers also reveal that crisis-hit NHS Lothian asked for an extra £32m from the Scottish Government to help hit waiting time targets, but did not receive the cash.

Monica Lennon, Scottish Labour’s health spokesperson, said:

“A £43 million black hole in NHS Lothian’s budget is alarming. This board is already in crisis and is seeing serious problems with A&E and surgery waiting times.

“Only weeks ago Nicola Sturgeon told Parliament that health boards are not facing cuts but that’s not the reality in the real world. Audit Scotland is warning that the health service in Scotland is not in a financially sustainable position under the SNP.

“The Health Secretary Jeane Freeman needs to outline a clear plan to get our health boards on to a financially stable footing.”

NHS Lothian, which has a budget of nearly £1.6bn, serves a population of over 850,000 people and employs nearly 20,000 staff.

However, a recent report by Audit Scotland revealed that it was the only board which failed to meet all eight national performance targets in 2017/18.

90% of patients are supposed to wait no longer than 18 weeks from referral to treatment, but the Edinburgh-based body’s figure was 74.6%.

Similarly, 95% of accident and emergency attendees should be seen within four hours, but NHS Lothian fell short at 75.4%.

Nine of out ten Child and Adolescent Mental Health (CAMH) patients should be seen within 18 weeks. In the Lothians, the figure stood at 65.1%.

Just over 66% of outpatients waited less than 12 weeks following a first referral, even though the standard is 95%.

NHS Lothian also failed to meet targets in relation to drug and alcohol patients and was second bottom of the league for patients starting cancer treatment within 31 days of a decision.

In addition, the new hospital for sick children has been delayed and an independent investigation found a culture of "bullying and harassment" in the organisation.

A paper written for a meeting of the board, titled ‘financial outlook’, stated that further financial problem are expected.

“The F&R [Finance and Resources] Committee also considered the initial assessment of the financial position for 2019/20. The paper highlighted a projected financial gap for 2019/20 of £43.1m, based on an initial assessment of cost pressures and anticipated funding,” it noted.

The board papers, which amounted to over 300 pages, also included a draft minute which focused on the challenges faced by NHS Lothian’s acute services.

Acute care is where a patient receives short term treatment for an urgent medical condition, as opposed to longer term care.

The document noted: “As part of the annual operational plan submitted to the Scottish Government Health Department a capacity gap of £32m had been identified in acute services that had in part previously been addressed through the private sector as NHS Lothian did not have sufficient capacity.

“It was noted that as part of the annual operational plan process that a bid for this quantum had been made to the Scottish Government Health Department but had not been received.

“In that respect the Chief Executive commented that it should not really come as a surprise that the sea of red performance areas continued."

NHS Lothian’s acute hospitals dealt with around 73,000 emergencies last year, 25,000 planned elective admissions and 52,000 planned day cases.

Scottish Tory MSP Miles Briggs said: “Once again we are seeing a major health board in Scotland struggling financially.

“This is a huge black hole in the finances of NHS Lothian, and it’s clearly unsustainable for them to remain in this situation.

“SNP Ministers have presided over the financial mismanagement of our NHS in Scotland at the same time as underfunding NHS Lothian.

“Given the record additional £550 million coming to the NHS thanks to UK Conservatives NHS budget increases SNP Ministers have no excuses to get our Scottish NHS onto a stable financial footing.”

Susan Goldsmith, Director of Finance at NHS Lothian, said: “Our annual financial planning cycle includes an early assessment of the likely additional costs and funding the Health Board will have in the following year. An up-to-date assessment of any financial gap next year will be informed by the Scottish Budget next week.

“Separately, the Board has undertaken an exercise to assess the cost implications of capacity required to deliver waiting times targets. We remain in discussion with Scottish Government colleagues following their recent announcement of additional funding for waiting times, to be confirmed in the Scottish Budget next week.”

A Scottish Government spokesperson said: “This year NHS Lothian received a 3.1% resource budget increase amounting to £41.8 million. In addition to this the board received £7.4 million to tackle waiting lists and a further £187,000 to introduce a sustainability plan.

“The board will also share £175 million to support health service reforms to meet the increasing demand and expectations placed on frontline services.”