The NHS is not in such rude health

HE latest figures on NHS waiting times, consultant vacancies and bed-blocking are likely to cause concern among ministers and civil servants and, if they are not, they should.

The figures show health boards are failing to meet key Scottish Government waiting times targets and confirm a worrying trend of slowly worsening performance on several fronts. Taken as a whole, they paint a picture of an NHS under growing pressure from an ageing population.

For the first time this year, an 18-week waiting time target from referral to treatment, brought in in 2011, has not been met. A second, supposedly legally binding guarantee that patients would have to wait no more than 12 weeks for treatment after a decision had been made to treat, is still being broken. Consultant vacancies are at record levels.

Meanwhile, the latest information on bed-blocking, where patients remain in hospital when they are well enough to be discharged, shows that the problem has dramatically worsened in the past year, with an increase of nearly 300% in the number of people waiting in hospital for four weeks or more. This, in particular, tends to suggest that efforts to keep patients out of hospital as much as possible to relieve pressure on the NHS from the elderly population are not yet working.

Bed-blocking can be reduced if there is a well managed system in place to care for the elderly in the community, bringing together GPs, social workers, community nurses and residential care homes, and is geared up to receive patients leaving hospital quickly and efficiently. Unfortunately, the figures hint that social services are struggling to cope with the pressures on them, just as hospitals are. The importance of tackling this problem cannot be overstated since there is a grave danger that demand for NHS beds will increase in future.

At the same time, boards are relying too much on agency nurses and A&E waiting times targets are still being missed by nine NHS boards.

The Scottish Government has a good track record on stewarding the NHS, but some sort of acknowledgment is required when a whole raft of health statistics show deterioration, or poor or lacklustre performance. Consultant vacancies, at 6.5 per cent of the overall posts, have risen significantly since they hit a low of 2.5 per cent in September 2011. Even though consultant numbers are up overall, the demand exists for every one of those vacant posts. Those doctors who are in post are under extreme pressure.

Making consultant contracts in Scotland more attractive could help boost recruitment without costing money. However, a debate about resources is necessary. The Herald campaign NHS: Time for Action has been highlighting the need for a review of NHS resources to ensure that the right beds and staff are in place to cope with the ageing population. A summit of leading health professionals last year concluded that an honest debate was required about the cost of looking after the elderly. That debate, and an open acceptance of the scale of the emerging problem, is required.