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The health service is never out of the political spotlight. Over the past three years, the NHS has been front and centre in two referendums, the Scottish election, and two general elections. And we live with the on-going debate over the impact we can expect from leaving the European Union and the possibility of a second independence referendum in Scotland.
Throughout this period of political instability, we at BMA Scotland have worked hard to deliver a consistent message to our politicians, urging them to focus on what must be achieved if healthcare is to flourish in Scotland.
We have urged politicians to be honest with the public about the finite capabilities of our health service. The financial difficulties facing the NHS in Scotland and the pressures on our clinical workforce are unrelenting.
Good health services cost money and health spending is a political choice. The UK spends a smaller proportion of its national wealth than the average levels spent by comparable leading European nations, and the BMA is calling for that to change, in all four nations.
We want the Scottish public to be consulted on what they need from the health service, and they must be told honestly how much it will cost.
Politicians must then decide if this is affordable, and if not, how they are going to bridge the gap – through additional funding, or by being honest with the public about what they are prepared to fund.
Shortage of doctors
One of the key areas we continue to highlight is that we simply do not have enough doctors in general practice or secondary care in Scotland to look after patients properly.
The most recent government figures show that more than 400 consultant posts in Scotland are unfilled, and almost half of these have been unfilled for more than six months.
Junior doctor posts lie empty in many specialties, and nobody is even measuring SAS doctor vacancies.
More than a quarter of all GP practices are missing senior medical staff. Doctors are just not applying for these jobs.
Add in the anxieties that many of our European friends and colleagues face about the impact of Brexit, and we risk a very real exodus of talented staff, along with difficulty in promoting Scotland as an attractive place to train and work as a doctor.
Scottish Government repeatedly says that 'there are more doctors than ever before' – but this is simply ignoring a major risk to the health service, and it is demoralising and frustrating for doctors to hear time and time again.
We need a realistic approach to workforce planning in Scotland which is based on an honest and shared understanding of the current medical workforce numbers, and an evidence based view of what future healthcare demand will mean for the number of doctors required. We need a clear and agreed approach to delivering and retaining this future workforce.
We need to be able to fill vacancies so that we can look after our patients properly and take care of our own health, reducing the risk of burnout.
Government and employers need to work with us, to listen to the opportunities we have identified for improving the working lives of training and trained doctors, and to take urgent action now.
Just this morning, Scottish Government has published a framework for improving workforce planning.
We’ll go through that in detail, looking for evidence that they recognise the crisis and are prepared to get serious in tackling it.
Health and social care integration
We passed motion 12 on Monday. Integration must be properly funded and politicians must stop raising false expectations of what it can achieve.
Our Chief Medical Officer has produced a report called Realistic Medicine in Scotland. This embodies the way we have all been taught to practise, and that we all try to practise.
It is about sitting with a patient, discussing all the options, and helping them to decide what is best for them. It is about patients having clear information about their own responsibilities for their health, about the full range of help available, and about how to use it.
It will only work if doctors and patients have enough time together to make joint decisions. And it will only keep working if doctors have the time to keep themselves up to date, and to train others to provide that expertise in the future. If the government and employers in Scotland are truly committed to realistic medicine, they need to demonstrate this by properly valuing the contribution and leadership role of doctors beyond the direct patient care they provide.
A lot of the ill health that our patients experience is due to many years of deprivation, inequalities, and poor public health. Prevention is better than cure, but doctors cannot fix the underlying social problems which so often have a detrimental impact on the physical and mental health of our patients. The Scottish parliament took clear action on smoking more than ten years ago, with very positive results for the health of our population. Minimum unit pricing for alcohol has been on the statute books in Scotland for five years, but the Scotch Whisky Association is fighting a disgraceful rearguard action through the courts, and this life-saving intervention is still not in operation.
Drugs and alcohol, obesity and poor nutrition, deprivation and health inequalities all blight the health of the people of Scotland. In the medical profession, we can, and we do, give advice based on best evidence, but it is a political decision, and a political responsibility, to take action.
And a last minute addition – I’m very pleased to tell you that Scottish Government has announced this morning that it will introduce legislation for a soft opt-out system of organ and tissue donation, in line with our policy and lobbying.
At BMA Scotland, we will continue to do all that we can to hold our politicians to account to ensure our health service in Scotland can respond to the pressures it faces now and in the future.
And, following our new President’s speech yesterday, I want to make it clear that there is full cross-party consensus in Scotland on continuing to fund our NHS from general taxation. We at BMA Scotland strongly support that.
And I want to finish by thanking Jill and all of the excellent BMA Scotland staff, as well as members of Scottish Council and the branch of practice committees, for all their hard work and support over the past year.
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