Audit shows 'worst-case scenario'

24 August 2011 Last updated at 23:18 GMT The health service is among sectors at risk from cuts Scotland's finances face a "worst-case scenario" and public bodies may struggle to manage budgets, an official report has said.

Audit Scotland concluded that Scotland's public bodies need to make significant savings this year.

Government policies such as free personal care, concessionary travel and free education could be put at risk.

The report found the scale of necessary reductions was in line with previously forecast worst-case scenarios.

Two years ago, Audit Scotland highlighted analysis by the Centre for Public Policy for Regions (CPPR) looking at three possible budget scenarios, ranging from a 5% real-term reduction at best, to an 11% reduction at worst.

The new report states: "It is now clear that the scale of the budget reductions facing Scotland over the next few years is close to the CPPR's worst case scenario."

Public bodies are facing increasing pressures and demands, such as Scotland's ageing population, the effects of the recent recession and the public sector's maintenance backlog.

Meanwhile, budgets will continue to drop. The planned 2014/15 budget of £25.9bn will be 11%, or £3.3bn, smaller than in 2010/11.

Pay restraint and reducing workforces are the most common approaches being taken by public bodies to reduce costs over the next few years.

Policies challenged

Robert Black, Auditor General for Scotland, said: "The public sector needs to reduce costs but there is also an opportunity to reform the way public services are delivered.

"Public bodies should overhaul the way they plan by looking at long-term sustainability, setting clear priorities and intended outcomes, and then setting their budgets based on these."

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It would be naive to expect that this will not have an impact on patient care and access to healthcare services”

End Quote Dr Brian Keighley BMA Scotland chairman The report poses a challenge to several key Scottish government policies such as free personal care, concessionary travel, free education and no compulsory redundancies.

"The likelihood is that, unless changes are made to areas such as eligibility criteria, demand for these services will increase the costs," it stated.

The report also suggested that budget pressures created by demand for free student tuition could be controlled without a change in policy, such as the introduction of fees, by limiting the number of spaces in colleges and universities.

Public sector pay costs will continue to rise - despite the public-sector pay freeze - unless staff numbers are reduced, according to the report.

The report also suggested that some so-called "efficiency savings" already carried out have actually been service cuts.

It suggested that further efficiency savings may not be possible without wholesale reform.

While the Scottish Government has imposed a no-compulsory redundancy policy in central government and the NHS, and is trying to compel other public bodies and local authorities to do likewise, Audit Scotland suggests that "workforce reductions are likely to be a significant source of savings" in the coming years.

Dr Brian Keighley, chairman of the BMA (British Medical Association) in Scotland, said: "It would be naive to expect that this will not have an impact on patient care and access to healthcare services."

'Spineless behaviour'

Labour finance spokesman Richard Baker said: "This sobering report makes it clear that our country faces challenging times and our public services will come under increased pressure."

Liberal Democrat leader Willie Rennie added: "Failure to address the challenges of an ageing population and the necessity of providing services on a tight budget means that there will be vulnerable people who will suffer because of the SNP's spineless behaviour."

Finance Secretary John Swinney said: "This Audit Scotland report is a useful reminder of the extremely challenging period ahead for whole of the public sector in light of Westminster cuts.

"It is imperative that every public body gets maximum value and delivers efficient and effective public services in constrained financial circumstances."

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Doctors defy their own advice, shows study

12 April 2011 Last updated at 00:43 GMT By Michelle Roberts Health reporter, BBC News Doctors may choose a different treatment if they were the patient Many doctors recommend treatments to their patients that they would not use themselves, a US study shows.

Experts asked nearly 1,000 US physicians to consider a medical scenario and pick a treatment.

But when doctors were asked to imagine themselves as the patient their answers differed significantly.

Doctors were far more likely to opt for a therapy carrying a higher chance of death but better odds of side-effect free survival, for example.

But for their patients, doctors tended to pick a treatment that erred on the side of survival, regardless of the quality of life, Archives of Internal Medicine reports.

Death risk

Faced with a choice of one of two operations to treat bowel cancer, for example, two-fifths of 242 physicians chose the surgical procedure with a higher rate of death, but a lower rate of adverse effects.

Conversely, when asked to make a recommendation for a patient, only a quarter of physicians chose this option.

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Our study does not suggest that physicians always make better decisions for others than they would make for themselves”

End Quote The research authors In another scenario, doctors were asked to imagine that either themselves or a patient was infected with a new case of bird flu.

They were told a drug treatment was available, and that without this treatment a person who contracted flu would have a 10% risk of death and 30% risk of needing hospital care.

Treatment would halve the rate of adverse events but also caused death in 1% of patients and permanent neurological paralysis in 4%.

Of nearly 700 doctors, about two-thirds chose to forgo the treatment when imagining they had been infected, to avoid its adverse effects.

However, when imagining that a patient had been infected, only half recommended not taking the treatment.

Dr Peter Ubel, from Duke University, North Carolina, and colleagues say: "When physicians make treatment recommendations, they think differently than when making decisions for themselves."

What is not clear is which is the best way to reach a treatment decision - putting yourself in the shoes of another or not.

Indeed, today doctors are often discouraged from giving their own personal opinion and instead are encouraged to present the relevant evidence and information so that the patient can make the choice for themselves.

"Our study does not suggest that physicians always make better decisions for others than they would make for themselves.

"At most, our study suggests that in some circumstances, the act of making a recommendation might improve decision making," say the researchers.

'Reliant on doctors'

Katherine Murphy, chief executive of UK-based The Patients Association, said it was "very telling" that the research had found many doctors may take a different course of action from the one they would advise their patients to follow.

"Doctors are of course human and will weigh up the options subjectively for themselves, no matter what they recommend to their patients.

"The difference is that doctors will have all the medical knowledge to back up their decision whereas patients are sometimes entirely reliant on their doctor for information.

"If the government is serious about making patient choice a reality, it must ensure that all patients have access to meaningful information in a variety of formats on all treatment options so they can come to a decision which is right for them."

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