Sobering assessment of Scotland’s NHS

Audit Scotland’s latest report on the Scottish NHS is sobering reading.1 It highlights costs rising because of inflation, higher utility costs, and pay and prescribing pressures; demand for services rising faster than activity post-pandemic; and operational challenges affecting patient safety and experience. It concludes that, without reform, the future financial sustainability of NHS services is in doubt. It calls for investment in prevention to tackle the causes of ill health, and the development of a clear national strategy for health and social care. Without this, according to Audit Scotland, long term planning will be more difficult for NHS boards.1

Would this be enough to achieve financial sustainability? To answer this, it is important to understand why the NHS is under such pressure. The demand for healthcare is a function of need and supply. Need is largely determined by trends in population health and illness (although need can also increase through expansion of what is deemed treatable over time). Average life expectancy in Scotland stopped improving around 2012, as in the rest of the UK. It worsened for people …