Experts say difficult decisions are needed to save the NHS
Senior health service figures tell us what can be done to fix issues
NHS Scotland won’t live to reach 100 years of age, top medics have warned, as they called for a wholesale reform of the healthcare system and laid out the challenges facing new Health Secretary Neil Gray, writes Joseph Anderson.
Here, key figures from the British Medical Association (BMA), the Royal College of Nursing (RCN), the Royal College of GPs, the Royal College of Emergency Medicine, and Scottish Care outline their demands for the reform of Scotland’s NHS.
Chief among their concerns is the ability to retain staff – the NHS is struggling to recruit and retain workers amidst low morale, harsh working conditions and disputes over sub-inflationary pay rises.
Scotland’s NHS is experiencing an intense amount of pressure due to staffing. Firstly, there is an immense Covid backlog to work through, which requires serious resources to tackle.
Secondly, a lack of staff is causing congestion at each stage of a patient’s journey through Scotland’s hospitals. There are limited care packages in the community due to staffing shortages, so vulnerable patients cannot be discharged from wards. Care workers can earn more and work in a much less demanding environment such as in supermarkets, and are leaving in their droves. The health organisations said this means vulnerable patients who are fit enough to leave hospital have nowhere to go.
Meanwhile, hospital wards are staffed by a minimal number of exhausted, overworked and, in the opinion of health leaders, underpaid staff. There are around 5,000 nursing vacancies in Scotland.
The pressure on wards is in turn causing congestion in accident and emergency (A&E) departments, where patients cannot be admitted to hospital beds that do not exist. Here too, staff are burned out and looking for the exit, reports suggest.
An A&E medic working in the Central Belt recently said pressures in NHS Scotland’s emergency departments had left staff “wondering how much more they can take”, with the only “good days” coming when doctors feel they “are not running around thinking someone is going to die”.
Waits of more than 24 hours have become normalised, as shown by the recent revelation that 4,000 Scots waited more than 24 hours in A&E in the first six months of last year – with some managers even admitting “they hope people just don’t turn up”.
As A&E comes under more pressure, patients have been left waiting outside in ambulances, meaning there are fewer ambulances available to attend to callouts. There are reports of patients waiting days for an ambulance.
At another of NHS Scotland’s “front doors” – meaning the first point of contact patients have with the NHS before being admitted to hospital – GP networks are said to be in disarray. Patients are presenting with illnesses that are more progressed, a hangover from the coronavirus pandemic when people didn’t seek help or couldn’t get it, and GPs are leaving the NHS or reducing their hours due to the pressure of work and low morale.
The BMA said that GPs were at “tipping point”, and some practices were “collapsing”. Figures have shown Scotland’s GP coverage has reduced by 3 per cent over a year – the estimated number of whole-time equivalent GPs in Scotland has dropped from 3,613 in 2019 to 3,494 in 2022.
The Royal College of GPs (RCGP) recently warned that the Scottish Government’s failure to retain and recruit GPs had led to “depleted and demoralised” doctors implementing “never before seen” emergency measures in surgeries, such as texting patients to warn them they can only take emergency appointments.
Dr Iain Kennedy, chairman of BMA Scotland, said that NHS Scotland was “a system bursting at the seams, with a workforce running on empty”.
“There are not enough of us to give our patients the time and care they need and deserve,” he said. “This winter is highlighting this challenge more starkly than most of us can ever recall.”
The proportion of people waiting longer than four hours in A&E in Scotland has risen sharply, new figures show. According to Public Health Scotland, just 60.8 per cent of people who attended A&E in the week to December 31 were seen within the Scottish Government’s target time of four hours before being admitted, transferred, or discharged. This represents a drop from 65 per cent the previous week.
The number of people waiting more than 12 hours during that week also rose by almost a third, from 964 to 1,271, while the number waiting longer than eight hours rose from 2,584 to 3,178.
Dr Kennedy said: “We know we don’t have enough doctors working to meet the demand and the health needs of our population. The Scottish Government must prioritise doing all it can to encourage more doctors to work in Scotland. They need to… look at the workload and working conditions that we are asking doctors and other healthcare workers to endure and take on.
“We know that the biggest risk factor to NHS Scotland’s recovery following the Covid-19 pandemic is our ability to retain the doctors we have, and to do that we need to treat them better.
“Far too many of our colleagues across primary and secondary care are leaving the NHS, retiring early or moving away, taking their expertise with them. Our workforce is buckling under the pressure.”
One way to alleviate the pressure in the healthcare system would be to make a career in care work more attractive, said Scottish Care’s Karen Hedge. She said that started with “properly valuing workers”.
“The social care workforce is professionally qualified and registered, and yet the government pays them the living wage and pays providers the equivalent of a living wage to pass on to workers,” she said.
The anti-immigration policies of the UK Government are also wreaking havoc on the care sector’s ability to recruit and retain staff, she said.
Dr Kennedy added: “I fear that without concerted effort, starting immediately, the NHS will not reach its centenary in 2048.”