Audit Scotland says NHS needs 'fundamental change'
Fundamental change is needed now if the NHS in Scotland is to cope with demand, according to the financial watchdog Audit Scotland.
In an overview of the performance of the NHS in 2014/15, Audit Scotland said the health service failed to meet seven out of nine key waiting time targets.
Problems around staffing have intensified, the report found.
Audit Scotland concluded this issue is "one of the biggest pressures facing the NHS today".
Auditor General for Scotland Caroline Gardner said: "We have highlighted concerns around targets and staffing in previous reports.
"These have intensified over the past year as has the urgency for fundamental changes such as introducing new ways to deliver healthcare and developing a national approach to workforce planning.
"It is important that the Scottish government and health boards work closely together to help alleviate these pressures and also increase the pace of change necessary to meet its longer-term ambitions."
The report points out that rural health boards in particular are struggling to attract and retain employees.
As a result they have to pay inflated prices for temporary staff. Whilst it costs an average of £15.62 an hour for an internal 'bank' nurse, employing a similar nurse from an agency costs £42.97. In Shetland, the cost per hour is £84.05.
The report also says that the health budget as a whole has decreased slightly since 2008/9 by 0.7% once inflation and capital spending is taken into account.
Health boards - which are responsible for most frontline services - received a slight increase of 1%, but not enough to keep pace with cost pressures.
The cost of drugs alone rose by 4% and is expected to rise by 5-16% in future.
Ms Gardner said: "We all depend on the NHS and its staff who provide high-quality care. But it will not be able to provide services as it does at present due to the number of pressures it faces within the current challenging financial environment."
Despite the pressures, NHS Scotland managed to reach the end of the year with an underspend of £10m, or 0.09% of its total budget of £11.4bn. However, many health boards needed to make one-off savings or received loans from the Scottish government in order to break even.
Health Secretary Shona Robison said that since the report was written, the Scottish government has announced a £200m investment to create six new treatment centres to help health boards meet increasing demand for a growing elderly population.
Ms Robison added: "The Scottish government welcomes this annual contribution from Audit Scotland, which confirms the Scottish government has increased the frontline, resource spending on our NHS.
"The Scottish government has a clear vision for the future of our NHS and we will continue to take the right action to ensure that Scotland continues to have an NHS that it can be proud of today and in the future."
'Substantive action needed'
Dr Peter Bennie, chairman of the British Medical Association Scotland, said: "The overriding message that must get through from this report is that substantive and realistic action is needed if our health service is to cope with the rapidly increasing pressures it is facing.
"As the report makes clear, increasing numbers of people are living longer lives, however, the amount of time that they will spend in need of support from the NHS is also growing.
"The NHS in Scotland is already coming under real strain as a result of these growing demands, continuing constraints on resources and increasing unfilled medical posts."
Royal College of Nursing Scotland associate director Ellen Hudson said: "If we are to put the NHS on a sustainable footing, then the government needs to take heed of the recommendations in this report and listen to what we and many other organisations have been saying for some time about the pressures on our health services."
Scottish Labour called the report "damning", adding the decrease in real terms of the budget shows the SNP has been cutting spending on health.
The party also highlighted that there has been a 53% increase in the use of private agency nursing staff, while 71% of vacancies for A&E staff were unfilled for more than six months.
Jackson Carlaw of the Scottish Conservatives commented: "We know about the pressures of the NHS in Scotland under the SNP government. Things are tough now and the service will deteriorate in the future if these problems are not dealt with now."
The Scottish Liberal Democrats said eight years of the SNP government has left the health service in "intensive care" while the Scottish Greens said the report revealed the Scottish government has not made sufficient progress towards its 2020 vision of more home and community-based healthcare settings.