Thank you, convener. Today’s report is my annual report on the NHS in Scotland, and it sets out how the NHS performed in 2018-19, financially and against national standards. The NHS provides vital health services to the people of Scotland. People are living longer and many are living with chronic health conditions, which means that demand for services continues to grow. NHS boards met just two of the eight key waiting time standards in 2018-19, but it is important to note that more people were seen and treated on time compared with 2017-18.
Achieving financial sustainability remains a challenge. In 2018-19, four boards needed a total of £65.7 million in additional financial support from the Scottish Government to break even. Half of all NHS savings were non-recurring and, although such savings help the annual position, they do not reduce costs or change services over the longer term.
We have identified several risks in relation to the NHS estate this year. Capital funding has decreased by 63 per cent over the past decade, and the cost of backlog maintenance is nearing £1 billion. High-profile new builds have also come under scrutiny because of health and safety concerns.
Despite the financial challenges and rising demand, staff are working hard to provide safe and high-quality care. There has been a significant reduction in mortality rates, and people’s reported experience of hospital care is improving.
The Scottish Government has taken steps to help NHS boards to address their financial challenges and to improve people’s access to care. Those include a shift from short to medium-term financial planning and the introduction of the waiting times improvement plan.
Health and social care integration continues to be a priority but, given that it is essential to future sustainability, progress is too slow. Local audit work has again highlighted a number of challenges that are getting in the way of integrating health and social care. NHS boards struggle to find time to support reform and integration while maintaining their acute services, and that is particularly difficult as demand rises. There is variation in the way in which NHS boards work with integration authorities to plan services and budgets, and several boards have reported integration authority overspends. Achieving recurring financial balance will be achieved only through whole-system service redesign.
My report highlights a range of workforce challenges that the NHS faces. Shortages are making it difficult to fill key roles in acute and primary care, particularly in rural areas. Agency costs remain high, and plans to withdraw from the European Union are likely to exacerbate existing pressures.
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There is more to do to ensure that all NHS staff are supported in a safe and respectful workplace that helps them to deliver the best care possible. The collaborative leadership that is needed is made more difficult by high turnover and difficulties in recruiting to senior positions in recent years.
The aims of the Government’s 2020 vision will not be achieved by next year. NHS boards are working on a significant number of local improvement initiatives, and we are seeing examples of new ways of delivering healthcare, but we are some distance from the large-scale, system-wide reform that is needed. The challenge for the Scottish Government, NHS boards and their partners is to agree new, more focused priorities and to create a culture that supports successful partnership working in order to deliver integrated care. That must include effective leadership, involving communities, and having clear and robust governance arrangements in place. My report shows that improvements are needed in all those areas.
As always, my colleagues and I are happy to answer the committee’s questions.