By stewartb

The Scotland page of the BBC News website has this headline (November 4): ‘Health board facing ‘unprecedented’ financial challenges, auditors warn.’ The article – the same story as covered by the Daily Record – outlines Audit Scotland’s reporting of the financial problems being experienced by Grampian and by Ayrshire & Arran health boards.

Never slow to provide quotable comments, we get the views of Scottish Tory health spokesman, Dr Sandesh Gulhane: ’.. the reports were symptomatic of problems facing the NHS across Scotland’. And a quote: “It’s appalling that health boards have been driven into crippling debt and are reliant on huge bailouts just to stay afloat. Grampian and Ayrshire & Arran are just the most extreme examples of a crisis facing all our health boards.”

Notice, here is a Tory – a member of the party that embraced austerity in government in Westminster for c.14 years – appalled about indebted NHS bodies? Does he have no sense of irony? (See below.) BBC Scotland’s Lisa Summers is quoted: ‘Audit Scotland has long been warning that the whole of the NHS in Scotland is financially unsustainable without a major rethink on what is affordable and what is not.’

What follows is an attempt to make good BBC Scotland’s context and perspective deficit!

From the Financial Times (February 12, 2025): Deficits at NHS trusts in England more than double.

‘NHS finances are as precarious as they were before the pandemic with deficits at health service trusts in England more than doubling over the past year, underscoring the challenges facing ministers in boosting community care.

‘The overall deficit for NHS provider trusts in England, which largely manage hospitals, stood at £1.2bn or 0.9 per cent of revenue in 2023-24, according to research by the Nuffield Trust think-tank.’

From the King’s Fund (May 18, 2025): ‘Tight budgets and tough choices: the reality of an NHS living within its financial means’. It states, with reference to NHS England: ‘Recent financial figures demonstrate this growing pressure. Since 2022/23, NHS spending has fallen slightly in real terms, while cost pressures have risen. Between 2022/23 to 2023/24, deficits across NHS systems doubled, going from £517 million to £1.4 billion.

‘Furthermore, in 2023/24, £900 million of capital funds for buildings and kit were reallocated to support spending for day-to-day running, even though the maintenance backlog now stands at £13.8 billion. This is despite the priority given to NHS budgets in recent fiscal events such as the 2024 Autumn Budget, which saw a £22.6 billion cash injection for the NHS in the context of broadly flat spending on other public sectors.’ (my emphasis)

This King’s Fund report provides an excellent, in-depth examination of the state of resourcing of NHS England and its ramifications. It quotes NHS trust leaders that: ‘sustainable finances required more honest conversations nationally and locally about the cost of delivering some services.’ In England this may be possible but in Scotland, with the likes of Gulhane and Baillie …?

The National Audit Office back in July 2024 published an assessment of NHS England’s finances: ‘NHS Financial Management and Sustainability’. (See https://www.nao.org.uk/wp-content/uploads/2024/07/nhs-financial-management-and-sustainability.pdf )

The NAO report states quite simply and starkly that ‘The scale of challenge facing the NHS today and foreseeable in the years ahead is unprecedented.’ And remember, this is referring to the part of the NHS in the UK which is the direct responsibility of Westminster government, the ONLY government in the UK with ALL the powers, with ALL the agency necessary to resource a FIX!

Below I select a some key observations in the NAO report which add further to the context and perspective missing from the BBC Scotland article referred to earlier – and that may be absent too from Audit Scotland’s reporting. The NAO’s findings certainly put the worth and integrity of the comments of the Tory health spokesperson in Scotland into ‘perspective’!

‘.. there is a wider question for policymakers to answer about the potential growing mismatch between demand for NHS services and the funding the NHS will receive. Either much future demand for healthcare must be avoided, or the NHS will need a great deal more funding, or service levels will continue to be unacceptable and may even deteriorate further.’

On debt and bailouts in England, the things that are so appalling to Tory Dr Gulhane in Scotland: ‘In 2022-23, the 42 NHS systems planned for an aggregated deficit (overspend) of £99 million against their total allocation of £119 billion, but their outturn was an aggregated deficit of £621 million. At the start of 2022‑23, only five NHS systems planned a deficit. However, at year end, 20 were in deficit. To provide additional financial support to NHS systems and cover their deficits, NHSE reduced planned spending against its own central budget in 2022-23 by £1.2 billion.’

‘In 2023-24, the 42 NHS systems planned for an aggregated deficit of £720 million, but their outturn was calculated to be an aggregated deficit of £1.4 billion. To manage pressures faced by NHS systems, NHSE received extra funding from the government during 2023-24, including £1.7 billion to support pay deals for non-medical staff and £1.7 billion to mitigate the impact of industrial action. NHSE also reduced planned spending against its own central budget in 2023-24 by £1.7 billion. These actions did not prevent NHS systems’ deficits increasing beyond what was planned at the beginning of the year.’ (By the way, that multi-billion pound bailout in 2023-24 would have come from Dr Gulhane’s Tory colleagues in government!)

And finally to those parts of the NHS in England in receipt of government assistance due to their financial predicament: ‘As of June 2024, NHSE’s Recovery Support Programme was providing mandated assistance to three ICBs (Integrated Care Boards), two of which had been in the programme since 2021 (along with their predecessor bodies), and to 21 trusts, seven of which had been in the programme since 2021.’

Let’s not forget Wales! From Audit Wales (29 August 2024): ‘All Health Boards breach break even duty amid deepening financial pressures’:

‘… seven health boards in Wales all failed to meet their statutory duty to break even over a three-year period. As a result, the Auditor General qualified his ‘regularity’ audit opinion for those bodies.’

‘Against a backdrop of significant demand, the total in-year deficit for 2023-24 has increased to £183 million (£150 million in 2022-23) and the three-year cumulative over-spend across the NHS increased from £248 million in 2022-23 to £385 million in 2023-24.’

‘… in general it is proving increasingly difficult for NHS bodies to produce financially balanced plans in the current climate of cost pressures and service demand.’ 

From Audit Wales on September 5, 2025: ‘Health Boards in Wales continue to experience significant financial challenges.’

‘Our audit of NHS bodies’ 2024-25 accounts showed that all seven health boards again breached their statutory duty to break even, raising further questions about the financial sustainability of the current system.’

‘…. the three-year cumulative over-spend across the NHS increased from £385 million in 2023-24 to £461 million in 2024-25.’

Is the provision of such context and such perspective as a public service too difficult professionally for BBC Scotland journalists or is the provision of such factual information avoided because, quite straightforwardly, its likely impact on voters would be at odds with the objectives that influence BBC Scotland’s editorial ‘leanings’ on political reporting?