A disturbing prognosis The Scottish NHS is collapsing ... but are doctors right in blaming the SNP?
Waiting times, ambulances delays, GP appointments
– the NHS in both Scotland and England is on its knees. To work out just how bad it’s got, we spoke to the two frontline doctors leading the campaign to save the NHS
THERE’S only one way to understand what has gone wrong with the NHS: sit down with the two doctors leading the campaign to fix our health service north and south of the border and get a diagnosis.
The Herald on Sunday invited Dr Julia Patterson, founder of EveryDoctor – the 1,500-strong doctor-led campaign fighting “for a better NHS” – and her Scottish counterpart, Dr Maria Corretge, to debate the state of our healthcare system. Patterson speaks for the UK and England, and Corretge, a consultant in West Lothian, speaks for Scotland.
Their assessment is utterly damning: the NHS is collapsing and may not survive; patient care is suffering profoundly; doctors are unable to offer the care they want, leading to unnecessary deaths; and political mismanagement is killing people. There are comparisons with “developing countries”, even war zones. It has emerged one Scottish patient waited 84 hours for treatment in A&E.
Crisis point
CORRETGE begins: “We’ve reached crisis point. There’s no adult conversation about how to save the NHS. Patients are suffering.
Outcomes in Scotland aren’t good. I chuckle when people talk about ‘excellent care’ because we don’t provide that.”
Corretge is a geriatrician, originally from Spain. “It’s very sad. When I arrived 20 years ago, care was quite good – now it’s not good. Waiting times for cancer and elective procedures are scandalous. Treatment for stroke is substandard. We’re letting down the most vulnerable.”
The Scottish Government isn’t “transparent”. The public “just doesn’t know” how bad it has become. “In my patch there have been bed closures and no noise about it.” One West Lothian hospital, St Michael’s, faces permanent closure, but “there’s no drama”.
Such losses, she says, “explain A&E queues”, adding: “It doesn’t take much to break the camel’s back now. The system is working at above 100 per cent capacity.”
Doctors now “discharge as many people as they can. If you don’t discharge, then somebody will be waiting extra hours in A&E. There’s no give in the system”.
Scotland’s drug death rate is much worse than England’s. But what really troubles Corretge is that in England “there’s loads of noise” about NHS decline, and calls for “government to do better. I don’t see that in Scotland”.
The indy problem
CORRETGE believes those most likely to complain – young left-wingers – “have been captured by independence”. She adds: “They don’t want to be critical of government. We’ve a pro-independence movement but nobody protesting saying ‘this is terrible’.” Independence supporters fear being seen as “lesser patriots” if they criticise the SNP. “Public debate has been kidnapped by independence. That’s a useful way of hiding things under the carpet.”
Patterson says England’s NHS has lost “almost 10% of its workforce – the worst it’s ever been. There’s 6.7 million on waiting lists. Ambulance waiting times are terrifying … We’re going into winter in a really scary state. The NHS has never been under more pressure”. Pay has fallen. Staff morale is low. The “right-wing press” scapegoats GPs.
Patient care is suffering profoundly; doctors are unable to offer the care they want, leading to unnecessary deaths; and political mismanagement is killing people
It’s “misrepresentation”, she says. “Simultaneously, the [UK] Government allows GP surgeries to be bought by American health insurance companies. None of this is being articulated to the public.”
Corretge is “seething” with Scottish Health Secretary Humza Yousaf. “Trust in him? Zero,” she says. “There’s no plan, no strategy.” SNP health policy is “vacuous”. Government in England and Scotland “avoid the massive problems that have eroded medicine in the last 20 years, and haven’t even apologised or acknowledged past mistakes such as reducing bed capacity”. When it comes to bureaucracy, too often decisions are taken by non-medical staff – “somebody not well versed” in what local communities need. The result? “Patients suffer.”
In Europe, where Corretge practised, “there’s very strong, very good and better public healthcare services”. One major problem is that “elderly people are very isolated. They need care and there’s no discussion how to pay for this. The care sector is deeply part of the problems we’re seeing in the NHS”. She adds: “We’re not providing excellent care – we’re providing very mediocre care and patients are suffering. Yet I don’t think anybody is acknowledging that in Scotland. We’re all ‘oh, we love our NHS, you’re all heroes’. But we must talk about difficult things.”
Privatisation
PATTERSON says there must be “an honest conversation about what people want”. Privatisation is happening but “it’s not reported. It’s really dishonest. Scotland now has dynamic purchasing systems similar to what’s happening in England. Bits of the NHS are starting to be privatised in Scotland, mirroring what’s happening in England. Private companies are infiltrating the Scottish NHS just like in England – although it is in its infancy in Scotland”.
She adds: “This outsourcing is happening and people aren’t aware. The NHS is getting worse and worse and privatisation is part of the reason. Everything should be laid on the table: this is how much privatisation there is, how much money there is. We need to have those debates and find a way forward. If we continue along this trajectory of privatisation by stealth, the NHS will just become a logo.”
Corretge says NHS staff are increasingly quitting as they’re overworked and underpaid. “It’s a pressure cooker.” When she was a junior doctor, Corretge worked 12 days straight with two days off. Staff aren’t doing that anymore. “People aren’t going to prop this up with goodwill anymore.”
Doctors are ground down. With staff leaving, “those who remain carry greater loads. The workforce has lost its stability. People are thinking ‘how much of myself am I meant to give to this career?’.” There is a lot of “burnout and stress” and there are simply not enough GPs available to promptly see every patient requiring help.
Blame for that doesn’t lie with GPs but politicians. “There’s a really old-fashioned attitude towards doctors,” Patterson adds, where they are expected to work harder than other professions. Traditionally, doctors worked exhausting hours because “that made a difference”, Corretge said. Now, however, doctors feel they “don’t really make a difference because it doesn’t matter how hard you work – if patients don’t have beds and are going to wait in A&E for 24 hours, we’re not seeing a difference”.
English comparison
CORRETGE adds: “Waiting times for cancer are longer in Scotland than England, waiting times for some orthopaedic procedures are longer too. Then there’s the drug death scandal – we do so poorly compared to England, and they’re not great.” Again, Corretge questions why young left-wingers “aren’t making a noise about this. Nobody is outraged”.
She says that clot retrieval, “the new procedure to save people from developing full stroke, is magic”, adding: “It has such great outcomes yet it’s not fully established in Scotland whereas it’s in most of England. I always say, ‘if you’ve a stroke in the borders, go south’.”
Clot retrieval is slow in Scotland as “we don’t have enough radiologists. When Nicola Sturgeon was health minster she cut places in medical schools. There was very poor workforce planning. Mistakes were made and now our outcomes aren’t good – 24-hour waits in A&E are now normal”. Once patients have been seen in A&E, if they need admitted “there’s nowhere for them to go”. She adds: “It is heartbreaking. You’ve very elderly, frail people sleeping in A&E as there aren’t beds for them.”
Deaths on trolleys
PATTERSON points to recent Royal College of Emergency Medicine (RCEM) figures showing that more than 4,500 patients died in England after waiting 12 hours on trolleys. RCME also found hundreds of patients died unnecessarily in Scotland because of A&E delays.
“Ambulance times are too long,” Patterson says. This and the fact that “you’re having to wait 24 hours for somebody to initiate your treatment is going to cause deterioration which will probably lead to some deaths”.
Corretge turns to “boarding” patients ~ – moving patients around wards to free up beds. “We already knew before 24-hour waits were normal that boarding patients increases the length of stay in hospital.” It also increases risk of delirium for the elderly. “For someone with just a few years left, that’s awful.
“Everybody can see people suffering. You’ve 90-year-olds sleeping on trolleys – of course that’s harmful. It breaks your heart.”