Report highlights “fundamental weaknesses” in Scottish NHS

BMJ 2010; 340 doi: (Published 30 June 2010) Cite this as: BMJ 2010;340:c3522
  1. Bryan Christie
  1. 1Edinburgh

    Staff seem to have been employed in the Scottish NHS in jobs of no productive value during years of financial growth, a report from the Scottish Parliament’s health committee says.

    Between 2002 and 2009 the number of medical staff in Scottish hospitals doubled, and there was a 76% increase in nursing staff. The report says, however, that hospital workload increased by considerably less than this.

    This “raises issues about the way the NHS system has been overseen and the way NHS Boards are made accountable for the use of limited funds,” it adds. “There is a sense that things have been allowed to drift during years of financial growth with inefficiencies allowed to continue.”

    The report has been produced after an inquiry into NHS spending and concludes that the failure to deliver productivity gains in line with the increase in resources points to “fundamental weaknesses in NHS management.”

    The health committee took evidence from representatives of several Scottish NHS boards during their inquiry and expressed surprise that efficiency savings being discussed had not been implemented years ago. Examples of this include merging equipment stores, reducing the use of bank or agency nurses, and driving harder bargains on procurement.

    It is concerned at the lack of a mechanism to ensure that good practice in one area is spread to other areas “within weeks or, at worst, months.” It recommends that local NHS boards are given greater direction on how to make efficiency savings on the basis of what has worked elsewhere.

    Although the committee says there is evidence that relatively straightforward savings can be achieved, the scale of the financial challenge facing the NHS in the next few years will inevitably mean that cuts will need to be made in more contentious areas. The absence of good data on patient outcomes and service quality means that it is difficult to identify savings that will not damage patient care. The report also says it is vital that NHS boards inform and involve the public in these decisions.

    The convener of the health committee Christine Grahame MSP said: “More staff have seemingly been appointed without any comparable rise in productivity because of the way budgets have been managed in the past. This raises a number of questions, including what criteria are being used to approve new spending and what standard of evidence is expected to support a spending plan.

    “The committee is concerned that mechanisms in place for holding NHS boards to account don’t adequately address efficiency within the service. We’re also concerned that reductions in budget growth, against a background of continuing rises in demand and inflationary pressures, will place the NHS under great strain.”


    Cite this as: BMJ 2010;340:c3522