High time for a grown-up debate on our NHS

It has been a time of difficult news for the NHS recently. Firstly, it was confirmed that all new NHS Scotland capital projects had been put on hold by the Scottish Government, and then, just days later, Audit Scotland produced its 2024 annual report, which was, to say the least, staggeringly bleak.

It is massively concerning for patients as to what this report means for them and their access to healthcare, but we must also consider what this means for those working in a health service in such a desperate state.

I’ve talked recently about moral distress and the effects on doctors and colleagues: constantly apologising for issues that are not their fault; struggling to do the best for patients despite the system being stacked against them; the impact on work-life balance. And that is without even mentioning the difficulties of working in crumbling buildings that are no longer fit for purpose.

It is simply exhausting and the frustration we feel is very real.

What is even more frustrating about the current situation, and recent Audit Scotland report, is that none of it is surprising. Audit Scotland has raised concerns about the sustainability of NHS Scotland for years. Healthcare staff are still not working in a culture where they feel confident to raise concerns.

Waiting lists are growing, which will only further embed the two-tier system we have seen developing, where ability to access timely care is based solely on whether you can afford it. The Scottish Government’s recovery plan has failed to effectively address even the longest waits for treatment.

While previous reports generated some heated political debate, we are still awaiting the development of a concerted, focussed, overall health and social care plan that moves us away from the kind of piecemeal, politically expedient action we see at the moment. The Scottish Government has sleepwalked into the current situation by continually ignoring the warning signs to meet growing demand.

And we have reached the point that we are now seeing the founding principle of the NHS – that it should be free at the point of need – threatened. This is the inevitable consequence of years of ducking the hard decisions and refusing to have a realistic and open conversation about what it is possible to provide within current resources.

Now is the time to have an honest discussion about our NHS, to build consensus around a plan for the future that will put it on a sustainable footing. Having a national conversation will require listening as well as sharing. The value of a healthcare system, free at the point of need, is priceless, there isn’t anyone who hasn’t been helped by our NHS.