An NHS target that must be delivered

HE NHS is no stranger to targets but the assertion by its chief executive Paul Gray that the problems it faces at present can be addressed within four years is among the most crucial. For all that the Scottish NHS in particular is a fine service with a dedicated body of frontline staff working hard to ensure a quality service at the point of need, it would be futile to deny there are significant problems and even greater threats looming.

This week’s Audit Scotland report on the condition of the NHS in 2016 was a stark assessment of the pressures faced in areas such as cost, staffing and capacity. Among its concerns were health boards over-budget and being asked to make cuts on an unprecedented scale; limited progress in reshaping services to deliver more health care in the community and away from hospitals; and slow progress in equipping staff for delivering care in new ways and settings.

Nicola Sturgeon insisted the solutions are already in place when she came under pressure over the Audit Scotland report at First Minister’s Questions yesterday. The Scottish Government’s record came under fire from opponents, with Ms Sturgeon’s own role as former health secretary highlighted.

To an extent, the Government’s defence is reasonable. It takes time to deliver the sort of major change that is being attempted, particularly in regard to initiatives such as the integration of health and social care. The issue of an ageing population is not unique to Scotland. But Audit Scotland found many initiatives are not delivering the results required, or promptly enough. Mr Gray essentially supports the First Minister’s assessment that, while seven out of eight targets set for health boards have been missed, the targets and the general level of performance are good when held up against international comparators.

Particularly welcome from Mr Gray is the commitment to deliver a clear plan addressing workforce issues and costs by the end of the year. This is what The Herald called for in our NHS: Time for Action campaign: a review of capacity in the hospital and community health care sector and an assessment of the resources needed. The lack of such plans was also a key concern identified by Audit Scotland.

Without this it is hard to assess the claim by Mr Gray that budget cuts being sought from health boards are achievable.

There is a tension between the requirement to reduce spending on acute care and the fact that, until such resources can be reallocated to community-based services, the need for acute care must still be addressed.

When reductions in spending are so severe change can be hindered. The drive can also be counterproductive, as shown by the high and increasing cost to the NHS of temporary and locum staff

It is reassuring that Mr Gray recognises the scale of the challenges and does not dispute the accuracy of the Audit Scotland report. He does not say what will happen if the four-year target cannot be met. But he has, to an extent, staked his reputation on the assertion that many of these problems will be addressed by 2020, when he is due to leave his post. We must all hope he can deliver.