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Securing a brighter future for care in Scotlands hospitals

Urgent, wide-ranging action is needed to ensure Scotland’s hospitals can go on providing comprehensive care for people across the country, the Chair of BMA Scotland’s consultants committee warned today.

Simon Barker was speaking as BMA Scotland published a detailed set of proposals for the future of secondary care – which is essentially all care provided in hospitals and through specialist services.

Secondary care matters: shaping the future of safe, sustainable hospital-based healthcare in Scotland sets out the challenges the services face and 20 key priorities that are necessary if we want to secure the future of care in our hospitals; if we want to ensure they are attractive places for staff to work; and if we want to improve the quality of care provided to patients.

It is intended as a positive contribution to provokede bate – put together following feedback from members and consultation with key groups from across the medical profession. Mr Barker, a paediatric surgeon based in Aberdeen, is clear that the current problems across the system cannot be allowed to go on indefinitely “without increasing risk and adverse consequences for patients”.

The 20 proposals are set out in three key areas – a collaborative and sustainably funded structure, a supportive culture, and a valued workforce. Examples include:

A collaborative, sustainably funded structure

  • Aiming to progressively increase health spending to 10 per cent of GDP in line with comparator countries in order to substantially increase resources available to the NHS. For example, in 2017/18, this would have resulted in a further £2.6bn in that year alone.
  • A more mature approach to targets that prioritises quality and recognises the constraints placed on the services by staff and finance shortages.
  • Services planned and informed 'from the bottom up’, reflecting patients’ priorities and local clinical expertise.

A supportive culture

  • Ending the culture which sees doctors fear they will be unfairly blamed for issues resulting from system-wide failings.
  • Empowering each of the consultant led care teams in our hospitals and trusting them to lead and innovate for how best to treat patients in their area.
  • Freeing health boards from mutually incompatible goals such as having to make stringent efficiency savings while delivering unachievable targets. We must stop demanding the impossible which only sets up services to fail.

A valued workforce

  • We need a fair system of pay and reward that better reflects the challenges and pressures faced by Scottish doctors and improves recruitment and retention. We must recognise the global recruitment marketplace and positively invest in the medical workforce to restore pay to appropriate levels after a decade of real terms decline.
  • Workforce planning must include a clear and unambiguous focus and investment on positive physical and mental health and well-being for NHS staff.
  • We need a clear, accountable and proactive strategy, both nationally and regionally, for involving clinicians ‘in the front line’ in the future direction of the NHS: strategic planning, service redesign, and local delivery plans. This requires a shift away from a central, top-down managerial approach to better reflect the diversity and expertise within secondary care at local service levels. 

Mr Barker said:

“I have frankly lost count of the number of times the Scottish Government has been warned that the NHS, as it is currently run, is simply unsustainable. The care provided in our hospitals suffers from a chronic lack of coherent planning, substantial underfunding that forces impossible prioritisation decisions on front line clinicians, and undeliverable targets which seem to be driven by arbitrary lengths of time, rather than quality of care.

“At the heart of this, things have become progressively worse for those delivering care. They are being asked to work in services with neither enough staff, nor enough money. Yet they are constantly being harried to deliver care within unrealistic timescales, in the face of growing demand, and in fear of making mistakes for which they will be blamed – rather than the wider shortfalls of the system. The result is morale is pretty much rock bottom – in particular amongst senior doctors. The refrain ‘work smarter’ is threadbare in a system that struggles to provide basic services from one day to the next.

“For the future of our hospitals and the people who depend on them, this simply has to change. If it doesn’t, we can no longer expect hospitals to provide the kind of comprehensive care we have always relied on them for. It's a choice that Scotland has to make, because doing nothing is making a choice. The inertia of recent years is a choice: a choice for reduced services, a choice for demotivated and fewer staff, a choice for less. 

“But there is still the opportunity to do things differently and transform the system that we work in for the benefit of patients. I hope the document we published today, which is focussed on solutions, will be a positive contribution to the debate about the future of care in hospitals. The people of Scotland need to decide what they want from our health service and then we can get on with delivering it - but services cost money. Magical thinking that we can have everything and not pay for it has to stop.

“As our proposals set out, we have to be honest that the starting point is a realistic discussion about funding. At the moment we don’t devote the same share of our country’s wealth to our health service – yet we expect to achieve the same, if not more than these similar systems. We need to address this and end many years of underfunding. The alternative is simply to accept the ongoing decline of the NHS, and that it won’t be able to offer the kind of comprehensive care we are so proud of for much longer.

“If we can fix the funding, we have then put forward a raft of proposals to secure a brighter future for the care provided in our hospitals. These range from a more mature approach to targets, better workforce planning, to truly looking after NHS staff and giving our front line consultants the authority as well as the responsibility to run services so we can concentrate on delivering the kind of care that the people of Scotland deserve.

“I remain convinced that this improved, sustainable service across our hospitals is what the people of Scotland, and the politicians who represent them, want. At the BMA we are committed to working with politicians of all parties to deliver a better future. We all owe it to our patients – both today and in the future – to strive to get this right.”


Tim Jays

Head of Public Affairs and Strategic Communications

BMA Scotland

(0131) 2473018/07768 005850

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