NHS Healthcare crisis has ‘no end in sight’, says medical leader
A TOP doctor says he would be “very nervous” if he needed NHS treatment or social care right now.
Dr Graeme Eunson described the situation in A&E departments as “horrific” and said he fears the health service is heading towards a “twin-track” system where people who can afford to pay will get better care.
Dr Eunson, a consultant paediatrician based at Borders General Hospital, was speaking to The Herald following his final meeting as chairman of the BMA’S Scottish consultants’ committee.
He will step down from the post he has held since 2019 in September amid a crisis that he says has
“no end in sight”.
He said: “The sad truth is a lot of the things we were warning about in 2019 are still the problems we face today, but all of these have been magnified by the pandemic and now the attempt to recover.
“We went into the pandemic with a workforce that was running on empty; now we’re trying to play catch-up from a very
difficult starting position.” Dr Eunson said pensions agency data for Scotland indicates the number of medics retiring doubled in 2021 compared to 2020.
He fears the trend is only likely to accelerate unless more is done to tackle a long-running pensions tax issue that can see senior clinicians penalised with annual bills running into tens of thousands unless they retire early or reduce their working hours.
“That’s something we thought was going to happen – that people would stick it out for 2020 and then retire in 2021 – but we’re worried that’s going to happen again and again and we’ll keep losing staff faster than we can replace them at the bottom,” said Dr Eunson.
“It just makes no sense not to be addressing a very simple problem that is having a disproportionate impact that far exceeds any nominal benefit to the Treasury.
“We have an ageing workforce and it’s driving people out, but the only way we’re going to get through the next five to 10 years is by retaining every possible member of staff we can.
“In the central belt – where you’ve got large hospitals and teams of 30 – you can smooth it out, but in small hospitals like my own or in the Highlands, Dumfries and Galloway, Ayrshire – the peripheries – you’ve got small teams, it’s really difficult to recruit, and if you lose that one key consultant it can be the difference between a viable service and a service that collapses.”
Dr Eunson said he also had a “very significant worry” that there will be an exodus of young doctors to Australia and New Zealand now that the borders have reopened, and where much lower rates of Covid over the past two years mean treatment backlogs have been minimised.
In Scotland, the NHS remobilisation strategy is banking on the creation of a network of dedicated elective hubs capable of delivering an extra 40,000 planned procedures a year by 2025/26.
While welcoming the aim, Dr Eunson cautioned that they risked “destabilising” acute care without a substantial increase in frontline staff.
The Scottish Government has set a target to recruit 1,500 new clinical and non-clinical staff for the National Treatment Centres by 2026.
“The worry is that this is going to be robbing Peter to pay Paul,” said Dr Eunson.
“Without a fundamental increase in the number of people we’ve got, all you’re going to do is take people who are working in very pressured district generals and move them into these hubs that offer a better working life.”
He stressed that hospitals are not “overwhelmed” by the total number of A&E attendances or admissions – which both remain below pre-pandemic levels – but because too many beds are being occupied by patients well enough to leave.
Dr Eunson added: “The whole system is clogged up because there’s no space in social care, so the whole hospital is full of people who are delayed discharge, which means there’s no beds for the acutely unwell people, who then end up backed up in A&E, which, in turn, means the ambulances can’t unload. So then there’s no ambulances to respond to the emergencies in the community.
“The whole system has ground to a halt, and every day you’re swapping risks: the risk of someone being looked after in an A&E department when that’s not the right place for them, versus the risk of moving them to an overstretched ward, versus the risk of discharging a patient sooner than they should be going home.
“These are the pressures we’re seeing day to day, but the impact of that is planned care is being kicked into the long grass, and if you’re on an elective orthopaedic waiting list you are essentially going nowhere.
“I would be very nervous if I were someone needing health and social care right now, because the whole concept that the NHS will be there for you at the point of need is a bit shaky.
“It does feel like we’re moving into a very two-tier system where if you can afford to pay you’re probably going to get a better service: be that paying for your own social care because the council-run services aren’t there or because you need an elective procedure and you end up paying for it because otherwise you’ll be waiting four years.
“That’s not the way it should be, but unfortunately I think we are going to end up with a twin-track system for quite some time.”
The Scottish Government has stressed NHS Scotland’s workforce is at record levels and that it has ploughed “significant additional funding” into social care, including £62 million to enhance care at home capacity;
£48m to increase the hourly rate of pay; £40m to provide interim care arrangements; and £20m to enhance multi-disciplinary teams.
Funding is also being used to
“rapidly scale up Hospital at Home” services.
The whole concept that the NHS will be there for you at the point of need is a bit shaky