I welcome Audit Scotland’s recommendations as set out in its recent annual “NHS in Scotland 2018” overview of the national health service. Indeed, the Scottish Government has already taken decisive action to deliver them. They highlight the challenges that our health service faces, which are similar to those that are being faced by health services across the United Kingdom and beyond. Importantly, the report acknowledges that our committed workforce has continued to deliver high-quality care. Today, I pay tribute to all our health and social care staff, who deliver outstanding services, day in and day out.
As the Auditor General recognised last week,
“demands on the service from Scotland’s ageing population are growing”.
For example, since 2013, we have seen 13 per cent more cancer patients receiving treatment under the 62-day referral standard, and increases of 26 per cent in computed tomography scans, 34 per cent in magnetic resonance imaging scans, and more than 15 per cent in child and adolescent mental health services patients. That is a small snapshot of the additional demand with which our health service is coping.
In addition to demographic change, we face price pressures and rising expectations. However, as the First Minister said last week:
“The task for us is not just to describe the challenge”—[Official Report, 25 October 2018; c 14.]
—it is to put the solutions in place. That is exactly what the Scottish Government is doing.
On 4 October, I published the “Scottish Government Medium Term Health and Social Care Financial Framework”, to give more detail on the potential approach required to deliver a financially balanced and sustainable health and social care system now and for the years ahead. Last week, I published our “Waiting Times Improvement Plan”, which will see more than £850 million of investment through phased, focused and decisive action to secure substantial and sustainable improvements in performance. Solutions will be different in different areas of the country and in different specialties, but the drive for improvement is national in scope, requiring a focused, intensive programme of work that accelerates action that is already under way.
From my statement on 4 October, members will be aware of my commitment to facilitate a new planning and performance cycle for all NHS boards. Audit Scotland has recommended that that is supported by a robust and transparent financial management system. That is exactly what we intend, and further detail on the new approach will be provided as part of the 2019-20 budget. The new arrangements will require boards to deliver a break-even position over a three-year period, rather than annually as is the case currently. In each year, boards will have 1 per cent flexibility on their annual resource budget, to allow them scope marginally to underspend or overspend in that year.
In its report, Audit Scotland recognised that a range of work was under way to strengthen governance arrangements, including piloting a standardised review of corporate governance across all boards. The review of NHS corporate governance that was carried out by John Brown and Susan Walsh will enable us to pursue the adoption of good practice across all boards. Yesterday, I met our NHS board chairs and tasked them with implementing those recommendations by the end of this financial year. Our review of progress with integration will report in the new year and will consider areas in which integration is working well, along with any in which governance and accountability can be improved. We are also committed to ensuring that all non-executive members of boards have the necessary training, skills and expertise to fulfil their roles effectively. We are addressing issues on leadership positions: project lift is a new approach to recruiting, retaining, developing and managing talent in NHS Scotland to ensure that the very best and most able leaders reach boardrooms.
Audit Scotland’s report recommends the development of a national capital investment strategy. I agree, and members will be aware from my statement on 4 October of my commitment to bringing a capital investment strategy to Parliament by the end of this financial year. The new strategy will create a framework considering necessary investment over the longer term and will accompany the medium-term health and social care financial framework to create an integrated overview of the funding that is needed across Scotland’s health and care system. It will include important investment in primary and community care projects, which will be key in delivering the emerging health and social care integration agenda and shifting the balance of care from hospitals to local facilities and people’s homes.
Audit Scotland recommended that a clear understanding of demand and capacity should inform workforce planning. Again, I agree. Our fully integrated health and social care workforce plan, which we will publish by the end of this year, will encourage all health and social care providers to adopt a comprehensive approach to workforce planning in order to ensure that workforce resources are deployed as efficiently as possible.
Finally, I welcome Audit Scotland’s recommendation about publishing clear and easy-to-understand information on how the health funding system works, including information about levels of spending. The Parliament knows that we are committed to ensuring transparency on health funding, and that we have recently introduced regular reporting of the financial position of NHS boards and integration authorities. That is essential in providing the clarity that is necessary for the important discussion that we will need to have about the future shape of our NHS and social care services.
Our financial framework was predicated on what I described in an earlier statement as
“the perhaps bold assumption that the UK Government will honour its commitment”
and
“deliver the consequentials as a true net benefit”.—[Official Report, 4 October 2018; c 50.]
I regret to tell the Parliament that the UK Government has failed to keep that commitment. I am very disappointed that yesterday’s UK autumn budget confirmed that the UK Government would short-change Scotland’s NHS by a total of £54.5 million next year, and by more than £270 million over the period to 2023-34. That the UK Government has short-changed our health service by £54.5 million, compared with its claimed level of consequentials in the summer, is an insult to our NHS and the people who depend on it.
In addition, the UK Government has not set out the consequential funding that would be delivered beyond next year, leaving open the possibility of the NHS funding commitment being further eroded, not least as the Chancellor has more than hinted at the potential of a totally revised budget from the UK Government as a result of its crashing us out of Europe with a no-deal Brexit.
Notwithstanding that disappointing—but, regrettably, not surprising—step by the UK Government, the Scottish Government remains committed to channelling every penny of health consequentials into Scotland’s health service. I can assure members today that, despite the actions of the UK Government, we remain committed to our programme for government promises and to our recently announced waiting times plan.
Returning to the Audit Scotland overview report, it is understandable that, due to the timing of the report, Audit Scotland was not able to fully reflect that the framework sets out additional funding for the health portfolio of £3.3 billion by 2023-24. That expected increase would mean an annual growth for the health portfolio of 2.9 per cent in real terms. As Audit Scotland’s report says, the Fraser of Allander institute predicts that the health resource budget is likely to have to increase by around 2 per cent per year to stand still. That is a vital point about funding and sustainability, which is not reflected—again, understandably—in Audit Scotland’s report.
I welcome the annual contribution from Audit Scotland. I accept the recommendations in full and, as I have set out in this statement, I am taking the steps necessary to ensure that the challenges are addressed. We have a record number of staff, record funding in excess of £13 billion this year and even more investment planned by the Scottish Government. Although essential, that will not be enough, and we must continue to follow our twin approach of investment and reform. I now look forward to working together with colleagues across the chamber in a responsible and mature manner to deliver that, and to ensure a balanced and sustainable health and social care system for the years ahead. I commend this statement.