Audit Scotland: NHS Recovery Plan 'difficult to deliver' and lacks detail

In its annual review of the state of the health service, Audit Scotland cast doubt on the Scottish Government's ability to tackle waiting list backlogs through the creation of a network of National Treatment Centres - a key plank of its NHS Recovery Plan.

The Government has earmarked £400 million towards establishing an additional eight dedicated elective hubs based on the Golden Jubilee blueprint, largely specialising in orthopaedics, urology, general surgery, eye procedures, and diagnostic tests such as MRI, CT scans, and endoscopy.

The first - in Forth Valley, Fife and Inverness - are timetabled to become operational this year, with facilities in Ayrshire, Cumbernauld, Livingston, Perth and Aberdeen due between 2025 and 2026.

Source: 'NHS In Scotland 2021', Audit Scotland

The Scottish Government has pledged to recruit an extra 1,500 new clinical and non-clinical staff for the NTCs by 2026, with a goal of ramping up inpatient and day case activity to 20 per cent above pre-pandemic levels.

Outpatient appointments are also due to increase by 10% above pre-pandemic levels through "redesigned pathways".

It comes as figures published on Tuesday revealed that the number of people in Scotland on waiting lists for inpatient, day case and outpatient procedures has ballooned to more than 500,000, with a further 140,000 awaiting diagnostic tests.

READ MORE: Scotland's new three-tier Covid plan explained 

Audit Scotland said the ambitions set out in the Scottish Government's Recovery Plan "will be stretching and difficult to deliver against the competing demands of the pandemic and an increasing number of other policy initiatives, such as plans for developing a National Care Service (NCS)".

It added: "The recovery plan will involve new ways of delivering services and these will take a lot of work.

"There is not enough detail in the plan to determine whether ambitions can be achieved in the timescales set out."

The Recovery Plan - published in August, before the Delta and Omicron waves led to many more planned surgeries being paused - includes a commitment to invest £11 million over the next five years in new national and international NHS recruitment campaigns, the creation of a Centre for Workforce Supply, and to fund an extra 100 undergraduate places at medical school.

However, Audit Scotland said staffing plans continue to be hobbled by a "lack of robust and reliable workforce data", adding that "innovative recruitment methods" will be required to deliver on staff goals.

Source: 'NHS Recovery Plan', Scottish Government

It also cautioned that the need to clear treatment backlogs will have to be balanced against staff burnout in the wake of the pandemic, noting that vacancy rates in nursing and midwifery, and for allied health professionals such as physiotherapists, were higher in September 2021 than in any of the previous four years.

A recent RCN Employment survey found that 61% of nurses are thinking about leaving their current position, partly due to excessive pressure and low pay.

"The ambition to significantly increase activity could undermine the desire to improve staff wellbeing," said Audit Scotland.

READ MORE: Vaccine passports scrapped from Monday in Scotland 

The watchdog said there also remains considerable uncertainty over how unmet need during the pandemic will impact on demand longer-term, with mental health referrals now exceeding pre-pandemic levels and concerns over missed cancer diagnoses.

Despite an "excellent" vaccine rollout, Covid also remains unpredictable, warned the report, stating: "There is potential for any new variant to spread more easily, to be more resistant to vaccines, or to result in more severe symptoms.

"These possible outcomes could all potentially divert efforts away from recovery and back towards the immediate pandemic response."

Source: 'NHS in Scotland 2021', Audit Scotland

Stephen Boyle, Auditor General for Scotland, said: "Putting Covid costs to one side, health spending is rising every year, meaning less money for other public services.

"There's now a clear opportunity to do things differently by building on the innovation and collaboration we've seen across the NHS in the last few years.

"For that to happen, our leaders must take the public with them and involve them in the shift from care being delivered in hospitals to much closer to people's homes.

"But better-informed policy decisions and services won't be possible without better collection and use of data."

READ MORE: Omicron is fading - but what kind of NHS can we really expect post-Covid?

Scottish Conservative Shadow Health Secretary Dr Sandesh Gulhane MSP said: “The report highlights the recruitment problem across the NHS - and that’s a product of poor workforce planning by the SNP Government.

"There are huge vacancies across the health service yet we can’t fill them because we don’t have enough trained people to do so.”

Source: 'NHS in Scotland 2021', Audit Scotland

Scottish Labour health spokesperson Jackie Baillie said: “This is just about the most damning Audit Scotland report in the NHS since devolution.

“The report is explicitly clear – the SNP government has entirely failed to support the NHS properly for years and as a result the whole system is under exceptional pressure.

“The failure of Humza Yousaf’s so-called NHS recovery plan is plain for all to see as one in eight Scots languish on waiting lists, staff are exhausted and the NHS remains on emergency footing.”

Health Secretary Humza Yousaf said: “The pandemic has put our NHS under the most severe pressure in its 73-year existence, and we welcome Audit Scotland’s acknowledgment that health and social care staff have shown extraordinary commitment.

“Staffing levels across NHS Scotland have reached a record high after an increase of over 7,600 whole time equivalent staff in the last year, and we are committing  £1 billion in our NHS Scotland Recovery Plan to get more patients seen as quickly as possible and tackle the backlogs of care.

“We also welcome Audit Scotland’s recognition of the actions taken to save lives during the pandemic through the vaccination programme, continued prioritisation of cancer services and Test and Protect.

"The report shows we worked quickly to support staff wellbeing – introducing a range of measures backed by £12 million investment, in addition to funding the recruitment of additional staff across a variety of health and care services.

“We agree with Audit Scotland that there is a clear opportunity to do things differently and build on the innovation and collaboration shown during the pandemic.

"That is why our work, including steps to improve data collection, and commitment to invest 20% more – £2.5 billion – in our NHS will support recovery and reform; delivering a more sustainable health and social care system that reduces inequalities and promotes good health.”