Three months ago, Audit Scotland published a damning report on the state of the Scottish NHS. In the report, the Auditor General highlighted the significant changes that were required to deliver a financially sustainable health service. None of this will come as a surprise to those working in the sector, but any hope of rapid change is likely to be hampered by financial, cultural, communication and innovation constraints.

Three months on and progress is limited. As policy and communication experts, we’ve looked at four challenges and how Scottish Ministers could look at addressing each of them. Scottish Ministers have a window this summer to put in place both policy and finance to address these issues.

The financial challenge

The financial challenge is at the root of the issue. NHS boards across Scotland are facing eye-watering deficits. These are not going to be fully addressed in the short to medium-term by any government. But instead of sweeping it under the carpet, the Scottish Government should publish a plan that shows what measures they are taking to bring NHS finances back under control. Starving NHS boards of capital funding could put new buildings and services back five years, so the public needs to know how the finances will be brought back on track. And with workforces still hugely stretched, talent is not going to be attracted into the NHS unless there is long-term funding and an updated workforce strategy in place.

The communications challenge

When the NHS is performing well, as it has in the past, communications are not an issue. But this is an election year and NHS services are struggling. As a result, political stakeholders and the wider public are asking questions about how services are being delivered. This is stretching hard-pressed communications teams with the NHS to breaking point. Embracing AI will help address productivity within these departments, but ultimately, they need the finances and resources to deliver effective communications.

The innovation challenge

The centre-point of the UK Budget’s proposed reforms to public services was the introduction of new NHS productivity measures. The productivity review is expected to release some £3.4bn of capital funding to support AI, digital and technological investments. Yet, none of this is new. The NHS has been innovating for years, maximising the use of data and technology as they have become available. The complexity lies in the roll out of these services, sustained finance and, critically, interoperability.

And none of this innovation change will be possible unless the finance is available to make it happen, much of which is dependent on the next Spending Review, which will take place after the General Election. There is little doubt that the NHS can save money, but it’s not an organisation that is adept at making swift changes – hence the cultural challenge.

The cultural challenge

If technology is a challenge, deep-rooted cultural issues are possibly even greater. There is much to admire in the NHS culture but due to its sheer scale, it can be slow to change. It also carries a great deal of political baggage, which can make reform difficult. What shape should the NHS take? Where should it step back, or provide greater support? And, most importantly, preventative healthcare needs a collective, joined up approach.

The NHS cannot solve the health problems of the nation alone. Some clinical settings can give way to a more inclusive community-led approach. Such changes require changes to entrenched roles and positions to embrace partnerships with the third sector, private sector or other parts of the NHS network. And, of course, it requires financial commitment to the preventative health agenda, just as the Audit Scotland report called for.

The NHS may not be at breaking point yet, but the cracks are certainly showing. The root issue certainly stems from funding constraints and the impact of both Brexit and the pandemic. Ultimately though, the NHS is in need of reform and the sooner ministers can grapple with that and make sure the finance is in place, the better.