Audit Scotland

Given the high profile nature of Audit Scotland’s work, it’s not unusual to be invited to address stakeholders at an event. So I’ll admit that I was nervous in accepting Voluntary Health Scotland’s invitation to speak at two workshops on our recent update on the progress of health and social care integration.

After all, integration is one of the most ambitious public sector reforms in recent memory, involving at least £8 billion of public money, millions of service users, 31 new integration authorities, and a potentially overwhelming number of lines of accountability.

And, some conferences or seminars can feel like the audience are there reluctantly. But these folk had volunteered to be there. What would be their expectations of audit? Would I live up to them? What hard-hitting questions could I expect?

Even more worryingly the first event, in Edinburgh, was captured live on Twitter, with comments and questions coming thick and fast via @VHScotlandComms and @AuditScotland using #healthandsocialcare. As a newcomer to the world of social media, I had imagined  the whole of Western civilisation putting its feet up for half an hour to listen out for any howlers.

Fortunately I had my colleague Rebecca Smallwood, who also worked on the health and social care integration report, alongside to help out if I lost my head (possibly by just sticking it back on and hoping for the best).

There was a lot of interest, with a number of individuals and groups from the third sector coming along: everyone in the room was keen to know more about how we’d approached our work on health and social care integration. There were a lot of questions and comments about where we might go next. Fortunately they were quite charitable. I think everyone recognised the risks highlighted in our report: complex governance arrangements, difficulties in agreeing budgets, and uncertainty about how services will be redesigned. If I had to sum up the mood, I’d probably go with ‘optimistic scepticism’.

It was much the same at our second event in Glasgow this week, and both experiences were very valuable for Rebecca and me.

How Audit Scotland engages with others, such as the voluntary sector and service users, is something we’re considering carefully at the moment, and it was refreshing and insightful to gain some alternative perspectives on what our role and focus should be in the months ahead.

So everything worked out in the end, and Voluntary Health Scotland kindly pulled together key messages and information from the events, available here. But there was a downside… I’ve now been asked to speak to another two meetings!

About the author

Gordon Neill, senior manager, has worked on a range of audits, particularly Best Value, over his 12 year career with Audit Scotland. He recently led on the first audit in our new series on health and social care integration.

The National Health Service is one of our most valued public services – one we all rely on at some stage in our lives, whether that’s as a patient, a carer, a family member or friend. So how is the NHS in Scotland performing and what lies ahead in its future?

Almost 140,000 NHS staff provide a variety of high-quality services, support and advice in hospitals, GP and dental surgeries, community facilities and patients’ homes in Scotland. The level and quality of care provided has contributed to people living longer, alongside continued advances in diagnosis, treatment and care.

Although Scotland’s population is living longer, demand for healthcare is increasing as older people are more likely to have complex health and care needs. In recent years, the cost of delivering health services has increased significantly, coinciding with a period of constrained public finances. In 2014/15, spending by health boards was £11.4 billion – around a third of Scotland’s total budget.

Last week we published our annual overview report on the NHS in Scotland, which looks at the performance of health boards and comments on the many challenges and pressures facing the NHS. It also looks ahead to assess what progress the Scottish Government is making towards achieving their 2020 vision which aims to enable everyone to live longer, healthier lives at home or in a homely setting by 2020.

It will come as no surprise to many people that the NHS continues to experience significant pressures such as tighter budgets, rising costs, tougher performance targets and greater demands on its services. Our report highlights that, overall, boards managed their finances well given the size of the budget and the scale of pressures faced. However, we found that performance against many of its key waiting time targets has deteriorated in recent years. Similarly, recruiting and retaining medical professionals is one of the biggest challenges facing health boards today, leading to more money being spent using temporary staff to help keep services running. Getting the right skills in the right place, on a permanent basis, is essential to ensuring an effective health service. We also found that the Scottish Government has not made sufficient progress towards achieving its 2020 vision. Our report says that they need to step up the pace of change and make fundamental changes now if it is to achieve its longer-term ambitions.

It’s clear that these pressures and challenges are going to be felt for a number of years to come. This means it’s more important than ever that the Scottish Government and health boards demonstrate value for money in their spending. It’s also why healthcare will continue to be a key focus of our audit work. In the coming months for example, we’ll be publishing the first of a series of reports looking at the new arrangements for Health and Social Care Integration as well as publishing our findings from work looking at changing models of health and social care in Scotland.

About the author

Michael Oliphant, Audit Manager, led the ‘NHS in Scotland 2015’ report team. He joined Audit Scotland in 2004 and has since managed a number of national performance audits looking at different areas of the public sector, including the Commonwealth Games, police reform, major capital investment and Scotland’s public finances.