This article was first published on our healthandcare.scot news service.

Holyrood’s public audit committee has raised concerns about whether delivery of the Scottish government’s plan of action to accompany its vision for reform will successfully reduce NHS delays and improve patient care.

Addressing the committee, NHS Scotland’s Chief Executive highlighted the need for improved monitoring and evaluation to gather the full picture of progress across Scotland’s NHS.

National public sector watchdog, Audit Scotland urged the government at the end of last year to set out clear actions to deliver its vision for NHS reform that support staff, bring down waits and improve patient outcomes.

In a recent evidence session, the public audit committee raised concerns around the timeline of implementation of strategies supposed to tackle these issues.

Giving evidence, Caroline Lamb, NHS Scotland Chief Executive and Director-General for Health and Social Care, told MSPs that better evaluation of progress is needed to “demonstrate the impact our reforms make”.

Ms Lamb explained that some improvement programmes, like A&E appointments “booked” by patients through the urgent care referral pathway, are currently not fully captured in NHS Scotland data – an issue acknowledged by Audit Scotland:

“Work has been underway and from the beginning of this year our reporting will include and capture that activity.

“We need to catch up our metrics with the changes and improvements we've been making to the way in which services have been operated.

“I think at the moment, the activity levels we're capturing slightly undersell what we're doing and we're very keen to address that.”

Scotland’s healthcare system is evolving to meet demand, Ms Lamb said, including through the introduction of scheduled A&E attendances – which is not captured by current monitoring.

Audit Scotland also said the government must improve transparency around the indicators the government uses to measure reduced waits to enable progress to be assessed and future planning.

Its report noted that Public Health Scotland (PHS), which monitors NHS activity, intends to include planned attendance figures in its NHS evaluations from February 2025.

Ms Lamb told the committee that government plans for NHS renewal – due to be published in March – will  provide clear milestones for short-term improvements alongside work to “capture new areas of activity”.

She added that evaluation work is also underway to build capacity, taking a “parallel-track approach” to tackle backlogs while working to increase the capacity and resilience of the NHS.

“A lack of transparency”

Challenging the government’s promises of action, committee convenor Richard Leonard MSP asked Ms Lamb to explain what he said is a “lack of transparency” around NHS recovery:

“The evidence appears to be that even when ambitions are set, progress reports aren’t made, milestones aren’t clear, there isn’t a real sense of progress being made.

“Why is this time going to be any different?”

He also questioned the commitment to deliver 150,000 additional appointments with a workforce crisis and a 10-year high of staff absence.

Ms Lamb said her team is working with health boards to tackle staff absences and vacancies to reduce agency reliance which she said has seen “some success”.

Although Scotland’s overall agency reliance has fallen, the latest figures show some health boards have filled more than 1,000 shifts with agency nurses in three months, with others report spending to 400% NHS pay to fill gaps.

This comes as the associate director of the Institute for Fiscal Studies told the BBC that record healthcare spending has yet to translate into significant improvements for patients.

Ms Lamb said that the government has brought together an “action group of leaders across health and social care sectors on the complex issue of delayed discharge to develop solutions.