How did under-pressure board end up overspending on treatment?

NHS Tayside is, quite correctly, often lauded for its overall clinical performance.

It is the flagship health board in terms of its accident and emergency waiting time performance.

When a chronic failure on child and adolescent mental health treatment was highlighted, a dramatic turnaround was achieved to quickly climb the Scottish Government’s league tables.

At the same time it has become a financial basket case that requires SNP ministers, in particular a sympathetic health secretary in Dundee MSP Shona Robison, to bail them out with millions of pounds every year.

NHS Tayside now owes ministers a total of £33.2 million and is almost certain to ask for its fifth consecutive brokerage deal, which sees central government cash loaned in order to subsidise day-to-day running of the health board, to see it through the next financial year.

The extra £4m will be handed over as health bosses try desperately to trim a surplus £49.8m, the amount identified as what needs to be saved in the first 12 months of a five-year plan aimed at balancing the books.

Alas, of the £45.8m that has so far been found, £5m has been “identified as high risk” with a further £12m marked as being “medium” risk.

So, how have things got to this stage? A recent report by Audit Scotland, the official and independent analysts of public finances, identified a number of reasons including, perhaps crucially, “the financial impact of national performance targets”.

The largest overspend for the 2015/16 financial year was in the medical group, closely followed by the surgery and theatres group.

Between these two vital services, they widened the gap between available cash and spend by almost £13.7m, an increase of £5.9m on the previous year.

Bearing in mind the overspend in the specialist services group was £2.9m, the obvious question is whether or not it is possible to keep a high standard of show on the road within the budget available.

There are, of course, serious issues around the likes of paying agency nurses and covering prescribing costs and NHS Tayside has made moves to bring the costs down on both, with particular success around cutting the use of privatised staff.

Fundamental questions remain, however, about how, or if, the board’s five-year plan will work.

Will cutting running costs end up costing patient care?