REALITY CHECK: IT WILL TAKE A DECADE TO BRING THE NHS BACK FROM THE BRINK
It could be 10 years before waiting times for operations return to pre-Covid levels, a leading surgeon has warned.
Dr Rowan Parks, president-elect of the Royal College of Surgeons of Edinburgh (RCSEd), said his prediction is based on modelling by surgical colleagues. He has urged NHS leaders and politicians to set realistic expectations for the public about the impact of the pandemic.
Parks, who takes up the presidency of the RCSEd in November, also urged ministers to accelerate NHS recruitment and redouble efforts to retain experienced staff.
His warning comes as independent health thinktank the Nuffield Trust revealed that Scottish nurses are quitting the profession at a higher rate than their counterparts in England.
Some 1,485 Scottish nurses left the profession in the six months to March this year, a rate
of 2.1% of the workforce, compared with the English rate of 1.7%, the Nuffield Trust independent health thinktank has revealed.
The trust says poor workplace conditions, bullying, lack of hot meals out of hours or time to eat are cited by nurses as major reasons for retiring early or leaving to work in other professions.
One Scottish nurse who has decided to retire early told The Sunday Post: “There have been many tears shed on our ward over the past few months, it’s not unusual to hear nurses crying quietly in the toilets during their shift; their patient load too great and number of nurses on duty during their shift too small.
“I live with the fear that I will make a mistake that will cause harm to a patient – or worse – because I’m so overworked and exhausted. We all live under this shadow.”
The Scottish Government published a five-year Covid recovery plan for the NHS in August 2021 but Dr Parks said it will take longer to return to the level of service provided prior to the pandemic.
Parks said: “We’ve asked some of our surgical colleagues to do some modelling. It does very much depend on what workforce can be expanded or developed but some of them are talking about, realistically, it could be a decade, it could be 10 years.
“Therefore, there has to be a conversation with the public and the realisation that the pandemic has had a significant impact. There were challenges before the pandemic but more than ever, we need to be setting realistic expectations.
“The NHS is a fantastic institution but it has been under enormous stress before the pandemic and the pandemic has exacerbated some of the real challenges around workforce retention and we have to ensure that we value the staff we have, retain the staff we have and make it an attractive career to bring new staff in.”
The latest official figures show the number of planned operations for the quarter to the end of June this year was 27% below the same threemonth period in 2019.
The figures also show the number of planned operations carried out in April, May and June this year – 55,758 – was 1.6% below the same quarter in 2021 when 56,672 elective procedures took place.
Parks said: “What the public need to understand is everybody is working their hardest to deliver healthcare to the population but there are realities and waiting times is one of those and we have to manage expectation. Waiting lists were creeping up before the pandemic but they have significantly worsened.
“We have done most of the efficiencies to increase throughput and with that we’re still seeing longer waiting times creeping in. So if we’ve got things running as efficiently as possible then the conversation has had to move to increasing capacity. That’s a conversation we started to have before the pandemic but it has really now been brought to the forefront.”
A key part of the recovery plan is the creation of 10 new national treatment centres (NTCs) but half of them are behind schedule.
A centre in Inverness due to open this year will open in April, 2023, while NTCs in Aberdeen and Livingston scheduled for 2025 are now expected to fully open in 2027. NTCs in Larbert and Kirkcaldy which were due to open this year will fully open early next year. Parks is supportive of the concept of NTCs but is concerned about how they will be fully staffed.
He said: “Ultimately, we need staff and that’s not just surgical staff. It’s all the associated staff. There does need to be expansion of numbers and efforts at recruitment but it takes time to fully train surgeons. That’s why we’re pushing to start that work now because the building of these NTCs will take a number of years. This isn’t a quick fix. It’s a three, five, eight-year plan to really increase the workforce to populate these new centres.”
Scotland’s spending watchdog Audit Scotland published a report in February which said the Scottish Government’s plans to recruit and retain staff are ambitious but will be difficult to achieve.
Auditor General Stephen Boyle also warned the NHS is facing a funding crisis. “One of the key conclusions in our report is that the NHS needs to reform to become more financially sustainable, rather than reinventing back to where we were before the pandemic on an already unsustainable model,” he said.
Last week Dr Lewis Morrison, a geriatrician who has led the British Medical Association in Scotland for four years, warned that the NHS faces a “terrifying winter”.
He warned that planned operations for those on waiting lists were likely to be cancelled over the coming weeks and “there is a risk that people will choose not to access healthcare when they are unwell because they are afraid of what joining the queue to get into A&E or get into the hospital will look like”.
He said there was a high chance of NHS staff going on strike, and that he was particularly worried about nursing staff. He said that nurses who had raised concerns about staffing levels compromising care had been told nothing
could be done. Nuffield Trust chief executive, Nigel Edward said: “Across the world there’s an issue with staff burnout, particularly post-pandemic. A lot of the focus has been on planning and recruitment, but a great deal more effort needs to be going into understanding why people are leaving and the problems with retention.”
Meanwhile The Royal College of Nursing Scotland is urging immediate action from the Scottish Government to improve working conditions to prevent the haemorrhaging of staff.
RCN Scotland head Colin Poolman, said: “With increasing numbers of nurses in Scotland leaving the NMC register, and many more telling us that they are seriously considering leaving the profession, it is up to the Scottish Government to act now to demonstrate to nursing staff that they are valued.”
Campaign group Doctors for the NHS said: “Nurses don’t leave because they get a better offer of money elsewhere.
“Similarly, doctors don’t desert the UK because they are after more cash. These people are leaving because they cannot tolerate impossible working conditions.
“Most are being worn out by the jobs they have to do, caring for people, as this government seems oblivious to obvious working conditions.”
The Scottish Government said: “The Health Secretary recently announced a new set of ambitious targets for NHS Scotland to address the backlog of planned care, which – as with health services across the UK and worldwide – have been exacerbated by the impacts of the global pandemic. We are working hard with NHS Boards to maximise capacity and opportunities in order to meet these targets.”
On staffing levels, health secretary Humza Yousaf said: “Staffing across
NHS Scotland is at a new record high and has increased for 10 consecutive years. NHS Scotland has more qualified nurses and midwives per population than NHS England.
“We know that the pandemic is not over and that Covid-19 and other pressures will continue to impact the NHS for some time. The Scottish Government recognises the significant additional pressure staff are facing across the health and care services, at this time.
“We made £12m available in the last financial year to support workforce wellbeing. We will continue to do all we can to seek to alleviate those demand pressures.”