The NHS in Scotland is not financially sustainable and its performance has continued to decline, the public spending watchdog has warned.
Audit Scotland said health boards were “struggling to break even” and none had met all of the key national targets – with NHS Lothian not meeting any.
It highlighted increasing demand on NHS services, and rising waiting lists.
Health Secretary Jeane Freeman said the government was already taking forward Audit Scotland’s recommendations.
But the watchdog’s report prompted widespread criticism of the Scottish government, with the Conservatives claiming it should “make shameful reading for the SNP”.
The report said pressure is building in several areas – including the recruitment and retention of staff, rising drug costs, Brexit and a significant maintenance backlog.
It said “decisive action” was needed to protect the “vital and valued service”.‘
What does the report say?
The report warned that the NHS in Scotland is “not in a financially sustainable position”, with NHS boards “struggling to break even, relying increasingly on Scottish government loans and one-off savings”.
And it said the “declining performance against national standards indicates the stress NHS boards are under”.
The only target met nationally in 2017/18 was for drugs and patients to be seen within three weeks.
Only three of Scotland’s regional health boards met the target for patients beginning cancer treatment within 62 days of being referred
The proportion of youngsters seen by CAMHS within 18 weeks fell from 83.6% in 2016/17 to 71.2% in 2017/18.
The Scottish government invested £13.1bn in NHS services last year, but Audit Scotland said when inflation was taken into account there was a 0.2% real terms drop in cash.
Health boards made “unprecedented” savings of £449.1m, but many relied heavily on one-off savings for this, while three boards – NHS Ayrshire and Arran, NHS Highland and NHS Tayside – needed £50.7 million of loan funding from the government to break even.
This was “significantly more” than in previous years, with Audit Scotland saying four boards have predicted they will need a combined total of £70.9m in this current financial year.
The report said the “NHS is managing to maintain the overall quality of care, but it is coming under increasing pressure”, adding Brexit would create “additional challenges” for the health service.
However the scale of these challenges was “difficult to assess” because of “significant uncertainty” over the terms of the UK’s withdrawal deal from the European Union, and because data on workforce nationality is not routinely collected.
Auditor General Caroline Gardner said: “The performance of the NHS continues to decline, while demands on the service from Scotland’s ageing population are growing.
“The solutions lie in changing how healthcare is accessed and delivered, but progress is too slow.”
What has the Scottish government said in response?
Health Secretary Jeane Freeman said the government was already taking forward Audit Scotland’s recommendations.
She said NHS funding had reached “record levels of more than £13bn this year, supporting substantial increases in frontline NHS staffing, as well as increases in patient satisfaction, reductions in mortality rates, falls in healthcare associated infections, and Scotland’s A&E performance has been the best across the UK for more than three years.”
She added: “While our NHS faces challenges, common with health systems across the world, we are implementing a new waiting times improvement plan to direct £850m of investment over the next three years to deliver substantial and sustainable improvements to performance, and significantly improve the experience of patients waiting to be seen or treated.
“Ultimately we want to ensure people can continue to look forward to a healthier future with access to a health and social care system that continues to deliver the world-class compassionate care Scotland is known for.”
What other reaction has there been?
Conservative health spokesman Miles Briggs claimed the NHS was “facing an unprecedented challenge” with boards across the country “staring into a black hole of more than £130m.
He said: “For a government which has been in charge for more than 11 years, this should make shameful reading for the SNP.”
Labour’s Monica Lennon added: “After more than a decade of SNP complacency our NHS is in crisis.”
Dr Lewis Morrison, chairman of the British Medical Association (BMA) in Scotland, said the “stark warning” from Audit Scotland “could not be any blunter”.
But he added this would “come as no surprise to frontline doctors who have faced the consequences of inadequate funding year after year”.
And RCN Scotland director Theresa Fyffe said the report “underlines what those in the nursing profession have been warning about for a number of years – an unsustainable pressure on staff to deliver more care.
“This leads to staff burnout and, in some cases, a choice between staying in the profession and their own health.”
Drug use to tackle mental health conditions in Tayside and Fife has rocketed by nearly two-thirds, it has been revealed.
NHS Tayside has increased its use of anti-depressants by more than 73% since 2007/8, while treatments for psychosis and related disorders have risen by 42%.
Pharmacies under the health board handed out nearly twice as much dementia medication, an extra 95%, and there was also an increase in the number of doses used to treat ADHD of nearly 175%.
NHS Fife recorded a slower rise in every treatment type except anti-depressants, where there was an increase of more than 90%. However, it experienced an overall rise of nearly 65%.
Only hypnotics doses decreased, with a drop of nearly 11% for Tayside and just over 2% for Fife. NHS Tayside, which paid out nearly £9.5 million for mental health drugs last year, an increase of more than 37% on 2016/17, insisted drug therapy can be important to recovery.
A spokeswoman said: “Increased levels of identification and diagnosis of mental health conditions, including dementia, means that more patients are accessing important treatments that can improve quality of life.”
TWO women bereaved by suicide have forged a bond as they fight for changes to health services to better protect vulnerable patients.
Karen McKeown and Gillian Murray met after the Sunday Post told how Karen’s partner took his own life despite repeatedly asking for help.
Luke Henderson died on December 29, 2017 after eight attempts to get help from NHS Lanarkshire in less than a week.
Gillian Murray’s uncle David Ramsay also took his own life two years ago today, after he was told to go for a walk and pull himself together by medical staff at NHS Tayside.
He had been rejected for treatment twice at the psychiatric unit at Ninewells hospital in Dundee, where an inquiry is under way into a series of serious concerns. Both Luke and David’s cases were raised in the Scottish Parliament by MSPs, and Karen met the mental health minister Clare Haughey on Thursday, although says she left feeling disappointed.
The mum-of-two said: “I appreciate that the minister listened to me, but that is really all she did. I don’t want sympathy, I want action, answers. Smiling and nodding your head just isn’t good enough.”
Karen was joined by MSP Monica Lennon during the 30-minute session.
The MSP has vowed to continue to push for answers on Luke’s case and both Karen, from Motherwell, and Gillian will campaign to demand a national inquiry to help establish stronger safeguards for vulnerable, potentially suicidal patients.
Karen and Gillian think the Tayside inquiry should be extended to cover the whole of Scotland.
Karen said: “This isn’t just happening in one place. Gillian and I are covered by two health boards and very similar problems happened with our relatives.”
Gillian added: “I know there are problems happening all over Scotland, that’s why we want an inquiry nationally.”
The Scottish Government said: “The tragic death of Ms McKeown’s partner is currently under investigation by NHS Lanarkshire. A key action in our new suicide prevention plan is to ensure we learn from every death by suicide and ensure lessons are acted on.”
Since I spoke out about what happened to Luke, I couldn’t believe the number of people who sent me messages saying they had similar experiences. One of them was Gillian, and her uncle David’s case was just so similar to Luke’s.
It looked as if he was experiencing psychosis, the same as Luke was.
The whole family didn’t seem to be believed by doctors, who said David was showing no signs of suicidal ideation. That is the exact same thing they said about Luke.
They told me Luke was ‘forward planning’ because he was saying he was looking forward to Christmas – two days away.”
People are dying, and it can’t keep happening. Karen has been through what nobody should have to.
Her partner killed himself in their home, even though she tried to get him help. Their children have to grow up without a dad. Nobody should have to suffer like this, and Luke should never have suffered either. He should have been given help, just like David should have been.
How many more people have to live like this, or die before the NHS will sit up and listen?”
The father of a young Dundee man who took his own life has welcomed the launch of a petition calling for a mental health crisis centre in the city.
Talented musician Lee Welsh died on August 8 last year. Now, almost a year after his death, a petition has been started in a bid to secure a 24/7 self-refer mental health crisis centre.
Since Lee’s death, his dad Phil has been campaigning for better mental health provision in Dundee under the banner Not in Vain for Lee.
Among his ideas is a crisis centre similar to one in Edinburgh. The centre in Edinburgh is funded by NHS Lothian, Edinburgh City Council and mental health charity Penumbra.
Phil said: “Something needs to change so people having a mental health crisis can have immediate access to support.”
The petition states: “As NHS Tayside reviews local mental health services, it must look to provide a new facility, offering emergency support 24 hours a day, seven days a week where people can self-refer.
“The crisis centre would provide access to counsellors and support in a home-like environment allowing people time and space to seek appropriate help.”
MSP Jenny Marra supports the campaign and said: “It would be designed to support the current system, which is too often unable to offer care quickly enough.”
Robert Packham, chief officer for Perth and Kinross Health and Social Care Partnership, said: “NHS Tayside provides support for people in Dundee in a mental health crisis 24-hours-a-day.
“The crisis intervention and home treatment service in Dundee assesses all psychiatric emergencies within office hours.
“Any person who attends Accident & Emergency in a mental health crisis would be seen by the liaison psychiatry service. There is also an emergency team based at Carseview Centre which operates out of hours.
“The nursing team is supported by on-call psychiatrists and sees people in crisis directly and referred from A&E.
“NHS Tayside has established an independent inquiry chaired by David Strang to review mental health services in Tayside.
“In the meantime, we are working with clinical, nursing and other staff to identify and act upon any areas which may benefit from improvement.”
Scottish Liberal Democrat leader has said the Scottish Government’s performance on aspects of mental health is “truly terrible” as waiting times are the worst on record.
Willie Rennie said instead of improving as promised, “performance continues to decline”.
Official figures published last week showed 71.1% of youngsters has an appointment with Child and Adolescent Mental Health Services (Cahms) within the 18-week government target – although the statistics from both NHS Tayside and NHS Borders were incomplete.
The figures, which cover the last three months of 2017, were the worst performance against the 18-week target since it was introduced in 2014.
Speaking at First Minister’s Questions, Mr Rennie said: “Last year the Mental Health Minister said performance on children’s mental health waiting times was encouraging.
“But only a year later, the performance is at an all-time low. Children have never waited longer since the targets began.”
He said the number of people taking their own lives in Scotland has increased and is at two people a day.
He added: “All of this is truly terrible. Why is it that people have to wait whilst this government gets its act together?”
First Minister Nicola Sturgeon said the long term trend in suicide is downwards and the government is working closely with health boards to improve performance on child mental health.
She said the average Cahms wait time across Scotland is 10 weeks, adding: “There is a great deal of very hard and good work being done to improve services for those who need mental health treatment.”