NHS could be envy of the world again. Here’s how ...
DEMORALISED. Discouraged. Fed up: the public sentiment that emerges from the latest survey into satisfaction with the NHS should put the frighteners on ministers both sides of the Berwickcarlisle line.
It’s that sinking feeling you get when you’re trying to get through to the GP, already knowing what’s to come: “Sorry, we don’t have any appointments left for today.”
It’s that anxiety about a loved one who’s in need of help and has no idea when they’ll get to see a specialist.
It’s that sense that doctors and nurses are too busy and you shouldn’t be bothering them unless you’re on the verge of collapse.
The word “crisis” has sometimes been misused in the past, but now it’s justified. It’s a grinding, attritional crisis. The latest British Social Attitudes Survey, the gold standard test of public opinion on the health service, shows that satisfaction with the NHS in Scotland, England and Wales is at its lowest level since the survey began in 1983. Just 24% of people say they are satisfied, a massive 29-point drop in three years, with waiting times and staff shortages the top concerns.
The NHS in Scotland is run differently to the service in England and in Wales, but here too people are scunnered.
Politicians, inevitably, blame the pandemic whenever the state of the NHS comes up. It would be absurd to ignore Covid’s effects, but the decline set in well before 2020. The Conservatives serially underfunded the NHS in the 2010s, as demand from an ageing population ramped up.
It’s striking that the last time satisfaction in the NHS hit a low was in the late 1990s.
Due to Scotland’s reliance on Westminster funding, this has had a knock-on effect here. The Scottish Government has topped up block grant funding for health, but many waiting lists are not just stretching up the street, but three times round the block and over the horizon.
Despite ministers often claiming that the NHS here is performing better than in England, Scottish patients struggle to tell. In some respects, such as waits of over two years, the picture in Scotland is considerably worse.
People are going private and spending their savings on hip replacements and knee operations, just to get respite from the pain.
That might warm the hearts of rightwing Conservatives but if they imagine voters see the NHS as a failing model of healthcare and the private sector as the answer, they couldn’t be more wrong: the survey shows overwhelming levels of support for healthcare that is free at the point of delivery. People just want it to work properly.
But can it ever again “work properly”? Perhaps it can, but only if politicians are prepared to take a brave long-term approach.
Lurching from winter to winter, plugging staff shortages by scouring the developing world for medical staff to poach from their own short-staffed health systems, is the definition of crisis management.
A long-term approach would include, not just better workforce planning, but a concerted effort to reduce demand in the first place.
Half of ill health in Scotland is preventable, so actually preventing it would have an utterly transformative effect on the NHS as well as on people’s lives. There would be no more shortages of GP appointments. Waiting lists would all but evaporate.
And the dire difference in healthy life expectancy between the most and least deprived areas of Scotland (26 years for men) would finally be cut.
Does that sound far-fetched? It does a bit, doesn’t it, but actually it shouldn’t – because the hard evidence exists to prove that prevention works.
Public Health Scotland is a big advocate of preventive measures to help the NHS and other public services.
It points out that the ban on smoking in public places in 2006, which wasn’t expensive to implement, led to a 17% reduction in heart attack admissions and an 18% reduction in childhood asthma admissions.
Efforts to prevent hepatitis C mean that Scotland is on course to eliminate it. And the multifaceted Childsmile initiative, which teaches children how to brush their teeth properly from the earliest age, supports parents and allows for children to receive fluoride varnishes, halved child tooth decay between 2003 and 2020.
Without these and other preventive measures, the NHS would be under even more pressure.
The human benefits – people living who would otherwise be dead, people working who would be stuck at home, children enduring fewer alarming asthma attacks and avoiding tooth extractions – are priceless.
Even illnesses associated with old age, such as dementia and cardiovascular disease, can be held off or prevented.
Some preventive measures are obvious, such as raising the rate of minimum unit price of alcohol and placing restrictions on alcohol advertising, both of which the Scottish Government says it will do. But others are not. The single best way to prevent ill health is to tackle poverty and deprivation.
Increasing the Scottish Child Payment, then, isn’t just about lifting children out of poverty now, it’s an investment in their future health.
Providing proper early years support, providing warm, dry, safe, affordable housing, decent, reliable jobs, and even tackling discrimination: all this improves people’s health.
Prevention is not the only thing that matters. Nearly half of respondents to the NHS satisfaction survey said they’d support tax increases to spend more on the NHS, which ought to reassure a spooked Labour leadership that they can be popular without following Tory fiscal policy.
But a significant number also believe there is waste in the health service.
Reform is required – better use of digital technology, for instance, and moving away from a focus on hospitals into communitybased care, better integrating health and social care. But preventing people getting sick in the first place is critical. People in Scotland die younger than in any other Western European country.
Are politicians brave enough to face down vested interests to reduce the consumption of health-harming products? Are they prepared to invest up front in measures that might not show health benefits for years?
We’ll struggle to rescue the NHS otherwise.
Preventing people from getting sick in the first place is critical