NHS in Scotland 2013/14 
Podcast script – 30 October 2014
I’m speaking today with Jillian Matthew, project manager at Audit Scotland, about our latest report, NHS in Scotland 2013/14. 
Jillian, can you tell me what is this report about? 
Yes, this report comments on the performance of the NHS in 2013/14 and its future needs. It's based on our analysis of the annual accounts of the 23 NHS boards, boards' Local Delivery Plans, financial information from the Scottish Government and NHS activity data.
And what have you found? 
Well, the NHS in Scotland is facing significant pressures, with tightening budgets and increasing demand. This is at the same time as needing to make major changes to services to meet future needs, and we've found evidence that NHS boards are finding it increasingly difficult to cope with these pressures.
All NHS boards met their financial targets, but several boards required additional funding from the Scottish Government or relied on non-recurring savings to break even. This approach to financial management isn't sustainable in the long-term. 
There have been improvements in the quality of healthcare, and the NHS has made good progress in a number of areas, including improving outcomes for people with cancer or heart disease and reducing healthcare-associated infections.
But the NHS is fighting pressures on many different fronts. Cost pressures, such as staff pay costs, and he growing costs of drugs and other health technologies, and rising pension costs, all exacerbate the tightening financial situation, and at the same time, the demands on the NHS are increasing as a result of demographic changes, particularly from the growing population of elderly and very elderly people; the number of people with long-term health conditions such as dementia or diabetes; and people’s rising expectations of healthcare.
All of this is taking place against a backdrop of the Scottish Government's ambitious 2020 Vision for health and social care. This aims to enable everyone in Scotland to live longer healthier lives at home, or in a homely setting, by 2020. It will be very challenging for the NHS to make the scale of changes needed over the next few years to achieve this vision. 
Now the report highlights that the current level of focus on waiting time targets may not be sustainable, especially given the increasing demand on services and tightening budgets. How is this focus affecting the performance of the NHS in Scotland? 
For the sixth year running, NHS boards broke even in 2013/14, and on the surface this appears to be good news, but the bigger picture is that some boards required additional funding from the Scottish Government in order to achieve this, while others relied on high levels of non-recurring savings. 
Boards are finding it increasingly difficult to meet performance targets, and some boards are failing to meet performance targets in certain areas. The strong focus on meeting waiting time targets isn't sustainable, and the considerable effort that NHS boards are putting into meeting challenging financial and performance targets each year makes it more difficult for them to focus on the long-term planning required to achieve the 2020 Vision.
Given the significant pressures that are outlined clearly in this report is there a risk that the 2020 Vision cannot be achieved? 
Well the NHS is facing significant challenges in making the changes they need to, to achieve the 2020 Vision within the tight financial resources available, which is why we are recommending that the Scottish Government review the current financial and performance targets for the NHS, to make sure that they do support the implementation of the Vision. 
What do you want to see happen now as a result of this report? 
The Scottish Government has set out its long-term strategy for the NHS, but boards don't yet have detailed plans in place. NHS boards and their partners need to develop clear plans about how they're going to deliver sustainable and affordable services to meet future needs. 
NHS boards and their partners also need to better understand the way that patients move around the complex health and social care system, and where there's blockages which are leading to patients not being able to get care they need, where and when they need it. This will help them to assess how they can delivery services differently to better match needs, and provide good quality care in the future. 
Jillian, thank you.