Protecting the NHS
First admit that it really can't go on like this anymore. Fundamental change is necessary.
Earlier this week, the Scottish Parliament held a short session focussing on the pressures facing the NHS this winter. Watching on, it was hard to imagine of a better example of the gap between the discourse of our political elite and the brutal reality on the ground facing doctors, nurses and patients.
Of course, Health Secretary Humza Yousaf conceded, the coming months will be “challenging”. A+E departments, he added, were facing “significant pressure”. But his overall message was that the Scottish Government’s recovery plan from the pandemic was progressing well. Opposition party spokespeople challenged him effectively, warning of the “catastrophe” taking place the ground. The overall impression, however, was of business as usual. Money will be invested. Plans will be rolled out. All will, eventually be well.
I think it is time we all admitted something important: no, it won’t. A basic acquaintance with honesty now requires politicians, and us, the public, to accept that the health service as we have known it over most of our lifetimes is now crumbling before our eyes, that it cannot carry on like this, and that only urgent and far-reaching reform can keep it going in the medium to long term.
This affects the entirety of the UK; it is not just a Scottish problem. But taking Scotland specifically, all across the NHS dashboard, alarm lights are now flashing red. Here are just a few. As of June this year, more than 450,000 new outpatients in Scotland were waiting to be seen, nearly 50% up on the pre-pandemic average. In Accident and Emergency units across the country, only 60% of patients are currently being seen within the standard four-hour target. Delayed discharge – whereby elderly patients who are well enough to leave hospital are forced to stay because there is no social care available for them – is up to record highs. While staffing may be up overall, nearly 12,000 staff members left the NHS last year, also a record high. And healthcare staff from five Unions are now balloting on whether to go on strike, an unprecedented state of affairs.
As if we needed any further confirmation of the fracturing of the NHS, figures at the weekend showed that the number of people in Scotland opting to go private for surgery is now up by 70% compared to numbers before the pandemic. These will not be rich people. They are thousands of ordinary Scots who have decided they would rather empty their savings than wait years to get a troublesome hip replaced. The time to warn about the “threat” of a two-tier health system is over. It’s already here.
The sum total of these bald statistics is causing something intangible and precious to break. The goodwill and good faith of medical staff who were once committed to the ideal of the NHS is withering. The support and near-adoration for the NHS among patients is cracking. The whole social contract upon which the NHS was built feels like it is close to collapse.
Enough: in Scotland and across the UK as a whole, we can’t ignore those alarm lights any longer with the promise of more sticking plaster. A few weeks ago, a major report was published by the Academy of Medical Royal Colleges, which represents 220,000 doctors around the UK. It could not have been blunter. Demand is going to rise over coming years thanks to our ageing population (the fastest growing age group in the UK is the over 85s). In Scotland, our age profile is even tougher. Without enough staff, the report concludes we will see “worsening waiting lists, a significant reduction in access to services across a range of settings and the experience of care being increasingly less safe and less satisfactory for patients.” Its chair, Professor Helen Stokes-Lampard, explained that the Academy doesn’t normally intervene publicly on public policy, preferring to stay in the background. But, she added, “having watched health and care systems deteriorate to the point where we are genuinely concerned that many NHS services are no longer safe, we have no option but to speak out loudly and clearly.” The time has come, she said, “for us to be honest with ourselves and with each other” about the need for change.
As always, the public is ahead of the politicians. According to the Health Foundation, nearly 60% of us agree that the NHS is getting worse. The story we used to (rightly) believe – that the NHS was an institution envied around the world – no longer holds true to us. We know things have to change. Yet, whether in Holyrood or Westminster, our governments remain too cautious. They fear the reaction to any plan for serious reform to our supposed “national religion”. Both the Conservatives and the SNP have long records to defend. And in Scotland, there is the added impact of the constitutional question. The Nationalist approach in Scotland is to keep the NHS show on the road. It does not want to create enemies or provoke fights; now when 50.1% of the population must be wooed. As geriaction Dr Maria Corretge told the Sunday Herald newspaper recently, our all-powerful independence movement seeks to hide the crisis from public view and look the other way. “Public debate has been kidnapped by independence. That’s a useful way of hiding things under the carpet,” she said.
I find myself no longer caring about whose fault this is, or who is to blame. Bluntly, in the face of a crisis which, if left unaddressed, will kill thousands of healthy people across Scotland and the UK, nor do I care about the low drone of constitutional warfare in Scotland anymore either. I’m solely interested in a political leader of any colour who has the imagination to grasp long-standing issues, known about for decades, with honesty, courage, and immediacy.
They’d begin by accepting the future of the NHS was on the line. They’d agree that continually adding more money from the existing pot cannot sort this; that while medical headcount does need to be increased, we simply cannot keep slicing the budgets of every other government service to feed the insatiable appetite of the NHS. Instead, they’d make it clear that the French and German models of healthcare, in which funding is sourced by a combination of government, insurance and users needs to be examined. They’d also properly bring together the NHS and social care so elderly people were not shuffled through bureaucratic hoops every time they want to leave hospital.
They’d end the pathetic point-scoring. Scottish Ministers would stop trying to claim a twisted form of success by noting we are 3% better than Wales or 5% less terrible than England. Instead, they’d seek common cause with Ministers elsewhere in the UK who face the exact same challenges and, on workforce, technology, regulation, and specialist services, they’d examine instead what could be done together.
None of this would be easy. But the whole point of the Scottish Parliament was to create a political powerhouse at the centre of Scottish public life that could take these kind of reforms through. What ever happened to that?
Scotland can do what it likes with its own NHS; this is entirely on us. This generation of politicians has to decide whether it is going to be the one that managed to sustain the NHS for future generations or whether it ground it into the dust. They won’t just put healthcare on a sustainable footing if they do – they might just prove to those of us who are giving up on the Scottish Parliament that it has a useful role to play after all.
ENDS
This article first appeared in Scottish Daily Mail, 5th October 2022