Scotland’s NHS workforce: The current picture

Major challenges lie ahead for the NHS in Scotland. As I reported last year, there are growing pressures on NHS boards which are struggling to juggle service delivery and progress major reform, at the same time as managing considerable financial challenges.

cover_nhs_workforceNearly 160,000 people work in Scotland’s NHS, which provides vital services for millions of us every year. Their hard work and commitment, sometimes in life-or-death circumstances, is always to be admired. However, the NHS faces challenges if the workforce is to meet the growing demands of our ageing population and adapt to new ways of working.

We know that our audit work on health and social care in Scotland has a role to play in the wider debate about what’s needed to transform these services and make them sustainable for the future.

Building on our recent findings, we’ve begun a new two-part audit to evaluate how the Scottish Government and NHS boards are tackling the issues, through workforce planning and national and local initiatives. The first report focuses on overall workforce planning and workforce pressures in hospitals and will be published in summer 2017. The second is due out in 2018/19 and will explore primary care and GP workforce issues.

In advance of our first report, this briefing provides some key information on the shape of the current NHS workforce and sets out some of the issues that we’re delving into during the course of our audit.

About the author

MM6A8690croppedCaroline Gardner is the Auditor General, and Accountable Officer for Audit Scotland. She started her term in July 2012, and has 30 years’ experience in audit, governance and financial management. Follow her on twitter @AuditorGenScot

Monitoring the progress of health and social care integration

Big changes are bringing together health and social care services in Scotland.

Traditionally, the NHS has provided health services and councils have provided social care. The new reforms will see these services planned and resourced by one local organisation, intended to create a seamless system which gives people the care they need, at the right time and place.

All adult social care and some health services including GPs, community healthcare, and certain hospital services (those which are mainly unplanned, such as A&E) are covered by the reforms. This makes the potential impact of integration wide reaching, as it involves services relied on by many. And as a country, we’re getting older, which means it’s likely the number of people needing health and social care services will increase in the years to come.

H&SCI_CoverIn early December, we published the first in a series of audits that we’ll undertake to monitor progress with the reforms. We found that the new arrangements are likely to be in place across Scotland by April 2016, but there’s more work to do to ensure that people using services feel the benefit of the changes.

We also found some evidence to suggest that local areas might not be in a position to make a huge difference in 2016/17. There are difficulties agreeing how much money councils and NHS boards will bring together to provide integrated services.  This, combined with uncertainty about much funding will be available in the longer term, means some local areas don’t have clear plans for how and when services will change.

If integration is going to make a real difference to people who use health and social care services, it’s important that all local areas make detailed plans for how they’ll make the necessary changes. It’s also important to be clear how they will measure the impact of these changes.

We found other issues that need resolved if the reforms are to be successful. For example, the new system is complicated, and it’ll be important that each local area makes clear, to both staff and the public, who is responsible for the health and social care provided.

There are also issues relating to available staff in health and social care. These include considering how this workforce can best contribute to changes to the services provided and how to recruit people into jobs where there are shortages of suitably skilled staff.

Like the different bodies involved in integration, Audit Scotland recognises the importance of getting this right and the consequences if that doesn’t happen, and we’ve made detailed recommendations to support improvement in our report to the Accounts Commission and the Auditor General. We’ll begin the next audit looking at the further progress of integration in early 2017.

In the meantime, we’re discussing our findings and recommendations with members of the Scottish Parliament’s Public Audit Committee on Wednesday (13 January). You can view the agenda, and watch the meeting live, via the Parliament’s website.

About the author

MM6A5569Rebecca Smallwood is an auditor and joined Audit Scotland in 2008.  She has worked on a number of audits with a health and social care focus, including community health partnerships, emergency departments and reshaping care for older people.

Health and social care integration: a radical change?

peopleSince my last blog, things have moved on across Scotland and NHS boards and councils are working with partners in the voluntary and private sectors and the public to set out how they will integrate care in their local area.

We’re now well underway with our work on this integration, speaking to a range of stakeholders and reviewing initial schemes for the new arrangements. We’re looking at what progress is being made, whether governance and financial arrangements are clear and the opportunities and risks this presents. This is our first piece of work on the new partnerships, and we’re working closely with the Care Inspectorate and Healthcare Improvement Scotland to take an early view on developments. Continue reading Health and social care integration: a radical change?

The Big Noise

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I began working with the GCPH in September 2013, on a project to evaluate the social and health impacts of Sistema Scotland’s Big Noise programme in the Raploch area of Stirling and the Govanhill neighbourhood in Glasgow. Both of these areas suffer from long term economic disadvantage, reduced educational attainment and poor health relative to most other areas in Scotland. Continue reading The Big Noise

Setting the scene: how audit is supporting health and social care reform in Scotland

audit_scotland_blogThe integration of health and social care through the Public Bodies (Joint Working) (Scotland) Act is one of the most significant public sector reforms of recent years. Public, voluntary and private sector organisations across Scotland are now working together to change the way that these services meet people’s needs. Continue reading Setting the scene: how audit is supporting health and social care reform in Scotland