Published: 20/12/2001, Volume III, No.5786 Page 8 9

The NHS in Scotland is facing relentless financial pressure which one-off cash injections will not relieve, the auditor general warned this week.

An Audit Scotland review of NHS finances shows that eight trusts failed to break even in 200001, with accumulated deficits totalling almost£54m - up£24m on the previous year.

Auditor general Robert Black praised overall financial stewardship in the NHS. But he added: 'It is clear that many trusts, particularly acute hospital trusts, faced mounting financial pressures in 2000-01. Indications are that these pressures are continuing.'

Mr Black told HSJ that it was important not to set too much store by the end-of-year figures for any single year. But he added: 'In some trusts, particularly acute trusts, deficits are building year on year. The longer this continues, the harder it is to deal with.The underlying trend is a cause for concern.'

According to the report, Overview of the National Health Service in Scotland, 2000/1, Tayside University Hospitals trust is in the worst situation, with a deficit of£15.9m. This arose from historical problems which have been the subject of a separate report and investigation by the Scottish Parliament's audit committee.

But the report shows that Tayside is by no means alone. North Glasgow University Hospitals trust, currently under huge pressure because of problems with the Beatson oncology unit, reported a£9.5m deficit. Grampian University Hospitals trust had a£4.9m deficit and South Glasgow University Hospitals trust (£4.1m) was also hard hit.

Argyll and Clyde Acute Hospitals trust, another trust with historical problems, reported a£3m deficit, while for neighbour Renfrewshire and Inverclyde primary care trust the figure was£1.1m.

Mr Black said the extra£90m for the NHS announced in September would help. But he stressed the 'one-off ' nature of the funds. 'Many trusts will be challenged by new and continuing pressures on budgets if they are to achieve financial balance, ' he said.

Local auditors have suggested reasons for the financial pressures, including rising service costs, increased expectation and new technologies, which he said were likely to continue on an upward trajectory.

The report also raises concerns about the rate of progress in developing proper processes for checking payments made to GPs, dentists, pharmacists and opticians, which add up to£1.3bn of NHS Scotland's£6bn budget.

Mr Black said no formal arrangements had been in place for checking such payments in 2000-01, but that Audit Scotland understood new procedures had now been agreed.

He said: 'The setting up of a fraud investigation unit is an important development.

'But all the initiatives need to be pursued urgently to ensure that there is a robust and consistent approach to payment verification across Scotland.'

So far in Scotland, signs are emerging that the situation is likely to worsen by the end of this financial year. Some trusts, which do not appear in the list of those with deficits this year, including Lothian University Hospitals trust, are making huge cuts to try to stay within budget.