Dear NHS, We need to talk about money

'Be upfront' about money issues in the NHS, warns Theresa Fyffe
'Be upfront' about money issues in the NHS, warns Theresa Fyffe

By Theresa Fyffe

We all know that money is one of the main causes of relationship breakdown and I’m sure the same level of disagreement happens in the Scottish Cabinet each year when the draft budget is discussed.

Yet funding for health has emerged relatively unscathed, while the overall budget for Scotland has shrunk. This is partly thanks to Nicola Sturgeon and partly realpolitik. What politician, after all, would wish to go against the public which holds our NHS so dear?

But as this week’s report by the Scottish Parliament’s Health and Sport Committee makes clear, there are concerns as to how the health budget of £11bn is actually spent.

And when politicians use phrases such as “may conceal underlying financial problems”, “glacially slow” and “the committee reserves the right to be sceptical”, then you know there are issues which need to be addressed. In relationship terms, it would be time for counselling; some thorough check-ups are needed for our health budget – and that’s just what the health committee will be delivering in a year’s time as it builds on this week’s report.

Among the biggest issues identified by the committee in its current report, problem number one is how do we take account of the impact of financial decisions on the quality of patient care? When demand is growing and the budget is at a standstill, this is something that must be tackled. Targets may be met by health boards, but that doesn’t mean patient needs are being met.

What happened with waiting times in NHS Lothian is one – albeit extreme – example, but how can we be assured that the health budget is delivering high-quality services that meet the needs of patients and our wider society? One answer is the government’s quality strategy, but with almost a third of the total Scottish budget being spent on our health services, the members of the health committee need to find meaningful ways of reassuring themselves – and the public – that the government and health boards have got the right balance between money and quality services.

Problem number two identified by the health committee concerns every politician’s favourite subject – preventative spend.  While universally acknowledged as good for patients and the public, preventative spend might not actually save money for the public purse. And even if there are savings to be made, these may well appear in another budget, not the one which funded them in the first place. So claims for savings from preventative spend programmes certainly need to be looked at more widely to make sure that plans to invest now to prevent health or social issues arising in the future is money well spent.

Next up, problem number three. While much of the rest of the public sector can only dream of the “protection” of its budget in these tough economic times, the committee asks the question “are the levels of health spending adequate?”. Or, to put it another way, is it enough to pay for the services that people need? This may raise some eyebrows, but given increasing demand, due to Scotland’s growing – and ageing – population, it is a very legitimate point. And as new services – for example, the Scotland-wide abdominal aortic aneurism programme – are introduced, which boards are expected to fund, how can the wider financial implications be assessed?

And so to problem four. Are efficiency savings, for example, just cuts by another name? Indeed, are non-recurring savings actually concealing “underlying financial problems”? This is something we have consistently highlighted, so we’re pleased the health committee is going to look into this in more detail the next time the budget is in its in-tray. We are concerned that health boards have been cutting their workforce to make short-term savings, badged as efficiencies, but which may impact patient care. Is this really what the public wants of its NHS?

The fifth problem raises questions about successive Scottish governments’ attempts to treat people at, or as close to, home as possible. Progress on this long-standing priority to shift funds and services from hospitals to communities has been, in the words of the committee “glacially slow”.

In our own work on NHS funding, we have found that getting up-to-date financial information from health boards can be challenging and have been arguing for greater transparency for some time. As demand grows and budgets, at best, stand still, it is clear some difficult decisions about the future provision of services will have to be made if financial and political harmony are to be maintained.

In any relationship, choices have to be made. And the only way that the NHS can avoid a breakdown and have a long and successful future is by bringing the public, patients, staff and indeed, politicians, with it when it makes those tough choices.

So three cheers for the parliament’s health committee for starting the debate on these crucial issues now about what the future holds for Scotland’s NHS. For as we all know, it’s much better to discuss money issues up front, rather than put it off until later.

Theresa Fyffe is director of RCN Scotland.

  • Robbie

    This is an extraordinarily poorly informed article by someone who claims to be knowledgeable.