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30 October 2014, 05:00
Doctors and nurses have called for an honest debate about the future of the NHS following an official warning that it cannot continue to provide its existing level of service.
Health spending is expected to fall at a time when more old people are heaping pressure on already overstretched services, public spending watchdog Audit Scotland has warned.
Health workers are doing longer, harder hours and the NHS is struggling to recruit and retain staff while a target culture leaves them feeling more disempowered and makes working in the NHS even less attractive, according to the British Medical Association (BMA), who said politicians now face "difficult and perhaps unpopular decisions".
Health boards are reliant on emergency funding or savings to balance the books and patients are being shunted through inappropriate wards or waiting longer, the Royal College of Nursing (RCN) said.
Health Secretary Alex Neil said the report has prompted a "refresh" of the Scottish Government's 2020 Vision to integrate health and social care after Audit Scotland warned "it will be challenging for NHS boards to make the scale of changes required".
Mr Neil said cuts from Westminster are having an impact but UK coalition parties in Holyrood say the SNP neglected the NHS during the independence referendum and have become a blockade to reform.
Audit Scotland said: "The overall health budget is planned to reduce by 0.9% in real terms over the next two years.
"Changes in Scotland's population mean that demand for health and social care will increase significantly over the next 20 years, at the same time as budgets are tightening.
"The NHS will not be able to continue to provide services in the way it currently does, given the scale of the changes required."
It added: "It will be challenging for NHS boards to make the scale of changes required over the next few years, but critical if they are to meet the 2020 Vision."
Dr Peter Bennie, chairman of the BMA in Scotland, said: "An honest, public debate about what needs to change to make the NHS sustainable in the long-term is urgently required and politicians must have the confidence and determination to make the difficult and perhaps unpopular decisions that may follow."
He added: "NHS staff are being asked to work increasingly longer hours, and more intensely, simply to fill the gaps.
"We warned last year that this situation was not sustainable and we are now starting to see real problems of recruitment and retention affecting hospital and GP services."
He continued: "The target culture has contributed to an increasing reality of disempowerment and a reducing sense of professional recognition amongst clinical decision-makers, contributing in turn to less attractive jobs."
Theresa Fyffe, director of RCN Scotland, said: "We need an honest public debate on how we can put the NHS on a sustainable footing for the future and this needs to take place now."
She added: "We've been saying for some time that the current situation is unsustainable.
"It's all very well saying that health boards are managing to balance their books but this is not enough, given that some health boards are relying on emergency additional funding from the Scottish Government or on non-recurring savings to do this.
"When patient care suffers because health boards are trying to make ends meet, it's obvious something is going wrong.
"People are being moved from ward to inappropriate ward because of a lack of space or shortage of care available at home, or are waiting longer for treatment and turning to A&E just to gain access to the healthcare they need. On top of this, vacancy rates across the NHS are on the rise."
Mr Neil today confirmed the Scottish Government will refresh the 2020 Vision strategy "to ensure that it reflects the increasing demands from patients and the new way services will be delivered under health and social care integration".
He said: "Protecting frontline health services is an absolute priority for this Government and we will do this by increasing the NHS frontline budget despite cuts in the overall budget from Westminster.
"The NHS is not perfect and we're always seeking to make improvements."
He added: "By evolving the long-term plan for NHS Scotland, this Government will ensure that Scotland continues to have an NHS that it can be proud of today and in the future."
Holyrood's Public Audit Committee will scrutinise the spending watchdog's concerns next week.
Convener Hugh Henry said: "The report acknowledges that the NHS has made good progress in a number of areas.
"However, it worryingly highlights evidence that NHS boards are finding it increasingly difficult to cope with significant pressures whilst changing services to meet future needs."
Scottish Conservative health spokesman Jackson Carlaw said: "It's no coincidence this report has come so soon after the referendum, showing that the SNP's obsession with independence for the past two years has resulted in the NHS and other public services being neglected."
Scottish Liberal Democrat health spokesman Jim Hume said: "People will wonder why the SNP Government are forcing Scotland's health service to limp on from year to year at a time when they should be strengthening its defences for the greater challenges of the future.
"This short-sighted approach has been proven to be bust through failing performance against a range of waiting times, staff shortages and an over-reliance on costly locum staff.
"Scottish Liberal Democrats have gladly supported Vision 2020 but it seems the only blockade to its success is the SNP Government."
Scottish Green health spokeswoman Alison Johnstone said: "The NHS is under huge pressure from austerity budgets and an ageing population.
"Over a third of the Scottish budget is spent on health but I want to see more of this directed at the root causes of poor health, as well as training new staff to replace the growing reliance on agencies."