NhS needs reform, but by evolution, not revolution

ACCORDING to Alex Salmond’s New Year message, Scotland has the potential to be the best place in the world to raise a family. Not if the doctors and nurses staffing the NhS are overworked to breaking point, it won’t be.

According to Dr Brian Keighley, chairman of the British Medical Association in Scotland, reports of stress and burnout are now emerging from all clinical grades of staff across Scotland. his warning chimes ominously with a similar message from the Royal College of Nursing earlier this month that nurses are working overtime for free in order to hold a creaking health service together.

Both the BMA and the RCN are trade unions whose job is to secure better pay and conditions for their members, so there is a temptation to take their warnings with a pinch of salt.

But they are also both significant bodies, so their common message should be heeded as more than just a call for more money to be put into the NhS. Neither are the causes of their concerns too hard to discern. Scotland’s population is ageing and the older the population gets, the more demands will be made on the health service. Treatments for previously untreatable conditions are constantly becoming available, many of which are expensive, both in terms of the drugs being used and the staff required to administer them.

Patients and their relatives know this and, since faith that the NhS is amongst the best health services in the world is strong, they expect that these cures should be available to all, everywhere. This rising expectation of an always-improving health service also extends to it being fully available at weekends as well as the five working days of the week.

In assessing how these increasing demands might be met, Dr Keighley makes two important points. Firstly, he contends that politicians should be open with the public that there is a limit to how much money can be spent on the NhS. This may seem obvious. Everyone knows that there is less taxpayers’ money than there used to be. The problem here, however, is political. The moment any politician starts saying this in the context of talking about the NhS, their opponents leap on it as evidence that cuts are being planned.

This is where Dr Keighley’s second point is important. he acknowledges that there is a case for reform – changing systems of work and procedure so that existing staff and money can achieve more. This, he contends, should be a matter of evolution rather than revolution – a gradual change of direction rather an abrupt about-turn.

Politicians, however, tend not to like this kind of reform as it seems gradual, piecemeal, and unambitious. But in trying to meet expectations which are rising faster that the resources available to meet them, an evolving NhS seems like the strategy most likely to succeed.