Scotland’s National Health Service (NHS) is facing increased scrutiny over its ability to meet its reform goals, with a recent public audit committee session highlighting gaps in the current metrics used to assess progress. Key issues include the ability to track the full scope of NHS activities and how that impacts patient care and waiting times. The lack of comprehensive monitoring is seen as a barrier to properly understanding the extent of improvements made and the effectiveness of new strategies.
Audit Scotland’s Urging for Clearer Metrics
Audit Scotland, the national public sector watchdog, has long called for the Scottish government to outline clearer, actionable steps to deliver its vision for NHS reform. This includes improving staff support, reducing patient wait times, and ultimately enhancing health outcomes. The urgency for better transparency and a more effective system of evaluation has become increasingly apparent, especially as NHS Scotland strives to adjust its services to meet rising demand.
In a recent evidence session, NHS Scotland’s Chief Executive, Caroline Lamb, acknowledged that the existing data collection systems are not yet capturing all the activities undertaken by the NHS. Some critical activities, such as scheduled A&E appointments booked via the urgent care referral pathway, were not being fully tracked. Ms Lamb explained that efforts are underway to address this gap, ensuring that improvements in service delivery are properly reflected in future reports.
“Work has been underway, and from the beginning of this year, our reporting will include and capture that activity,” Lamb told the committee. “We need to catch up our metrics with the changes and improvements we’ve been making to the way in which services have been operated.”
New Reporting Standards to Capture Full Activity
Public Health Scotland (PHS), the body responsible for monitoring NHS activity, plans to include these previously overlooked figures—such as planned attendance data—into its NHS evaluations beginning in February 2025. This marks a significant step toward making the NHS’s activities more visible and accurately measured. However, the challenge remains in ensuring that these new metrics truly reflect the improvements and changes taking place within the system.
NHS Workforce Challenges Remain a Key Concern
Despite strides in addressing data transparency, Scotland’s NHS continues to battle workforce issues, particularly in the face of significant staff absences and vacancies. With a growing number of shifts filled by expensive agency workers, some health boards are facing increasing reliance on agency nurses, exacerbating an already stretched budget.
The Scottish government has taken steps to address staff shortages, with NHS Scotland working alongside health boards to reduce agency use and improve staff retention. However, the latest figures show that some health boards have filled more than 1,000 shifts with agency nurses in just three months, leading to costs that are up to four times higher than standard NHS pay. This has sparked concerns over the sustainability of the healthcare system, especially as the workforce crisis continues to affect patient care.
Committee convenor Richard Leonard MSP questioned NHS Scotland’s lack of transparency and progress, emphasizing that despite previous ambitions, there have been few clear milestones and limited progress reports. Leonard’s comments reflect wider skepticism over the effectiveness of the reform strategies, especially when coupled with the ongoing staffing challenges.
Government’s Plan for NHS Renewal
Caroline Lamb assured committee members that NHS Scotland’s upcoming reform plan, due to be published in March 2025, will include clear milestones for short-term improvements. The government is also focused on building capacity within the system, addressing the existing backlogs, and increasing the resilience of healthcare services across Scotland. Lamb highlighted that a “parallel-track approach” is being pursued, with efforts aimed at reducing delays while enhancing capacity for future demand.
In response to Leonard’s questions about the promised additional 150,000 appointments, Lamb emphasized the need for collaboration across the health and social care sectors. She stressed the formation of an action group specifically aimed at tackling delayed discharge, a complex issue contributing to the wider NHS pressures.
Looking Ahead: Will NHS Reform Deliver?
While NHS Scotland is taking steps to address the challenges it faces, questions remain about whether the proposed reforms will lead to meaningful change. The upcoming publication of the NHS renewal plan and the government’s commitment to improving both staff support and patient outcomes will be crucial in determining whether Scotland’s healthcare system can meet the needs of its population in the coming years.