Our NHS is highly valued, accessible to all, free at the point of use, and takes care of the nation’s health needs from cradle to grave. Yet the challenges facing it today are unprecedented, raising complex questions about how we can sustain our health service for future generations. Much of the focus this year has been on constitutional issues surrounding the UK’s exit from the European Union. BMA Scotland will continue to raise the potential severe consequences for universities and the NHS in Scotland. But we must also ensure that the overall condition of the NHS does not slip down the list of priorities.
Report after report on the state of the NHS in Scotland have set out the increasing scale of the challenges the health services faces.
Audit Scotland reiterated what BMA Scotland have been saying for some considerable time.
The NHS in Scotland is struggling to cope.
But despite the body of evidence to show that urgent action is needed now, the much needed plans for action have been allowed to slip.
Holyrood's Health and Sport Committee has drawn attention to major problems with recruitment and retention across the health and social care sectors in Scotland - not just the NHS – and they highlight specific issues in remote and rural areas. The Government's response must not simply repeat the tired mantra that Scotland is spending more money on the NHS than ever before, and has more nurses and doctors than ever before. This completely misses the point. Vacancies in the medical workforce are increasing and the range and scale of pressures on the service continue to grow. There are significant problems in recruitment and retention of doctors, nurses and allied health professionals, yet the official figures still struggle to capture the real extent of medical vacancies.
Action is needed now to make Scotland a more attractive place to work if we are to address these vacancies which exist across consultant, GP, trainee and specialist posts. This is an area where the health service needs to do better and the health and social care workforce plan which is due early in the New Year is a big opportunity to make progress in this area.
As Scotland's population profile gets older and has increasing health needs, the speed with which increasing demand is outstripping available resources is rapidly growing. Without sufficient resources, providing healthcare in the same way as we do now is becoming unsustainable. Funding is not keeping pace with the demands on the health service. It has been virtually stagnant across the UK since the onset of austerity – which is hitting the health of the public, especially the poorest in society, resulting in even greater demands on the NHS.
The UK spends a lower proportion of its GDP on healthcare than most comparable EU countries and the gap has been growing in recent years.
If the NHS does not get the resources it needs to keep pace with demand, then the only alternative is to look at the range and models of services that can realistically be delivered within the budget provided. If the gap between demand and resources is going to continue, then there is no choice but to ask what the NHS in Scotland can and can’t deliver in the future.
Any change, particularly at a local level, can often seem too hard to achieve especially when there can be political mileage to be made in supporting the status quo.
At the BMA, we have been calling for an honest, public debate about whether or not Scotland is willing to invest the resources that the NHS needs to deliver the current range and level of services. We will continue to emphasise the need for this debate with the public and politicians as discussions take place about the health and social care delivery plan which was recently published by the Scottish Government.
If politicians and the public are not prepared to accept changes to the way healthcare is delivered in their area, how are any changes actually going to be achieved? Failing to tackle these issues will do nothing to solve the problems of an NHS that is overburdened and underfinanced and where staff, the bedrock of the service, feel burnt out and anxious about working in such a challenging operating environment. Let’s make a commitment for the New Year to set our sights firmly on finally developing and delivering a clear plan for an appropriately designed and resourced NHS in Scotland.
Peter Bennie is the chair of council for BMA Scotland