BMA leader warns Scotland headed for 'two-tier' healthcare

Dr Eunson, a consultant paediatrician based at Borders General Hospital, was speaking to the Herald following his final meeting as chair of the BMA's Scottish consultants' committee.

He will step down from the post he has held since 2019 in September amid a crisis which he says has "no end in sight".

He said: "The sad truth is that a lot of the things we were warning about in 2019 are still the problems that we face today, but all of these have been magnified by the pandemic and now the attempt to recover.

"We went into the pandemic with a workforce that was running on empty; now we're trying to play catch up from a very difficult starting position."

Dr Eunson said pensions agency data for Scotland indicates that the number of medics retiring doubled in 2021 compared to 2020, and he fears that the trend is only likely to accelerate unless more is done to tackle a long-running pensions tax issue which can see senior clinicians penalised with annual bills running into tens of thousands unless they retire early or reduce their working hours.

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"That's something we thought was going to happen - that people would stick it out for 2020 and then retire in 2021 - but we're worried that's going to happen again and again and we'll keep losing staff faster than we can replace them at the bottom," said Dr Eunson.

"It just makes no sense not to be addressing a very simple problem that is having a disproportionate impact that far exceeds any nominal benefit to the Treasury

"We have an ageing workforce and it's driving people out, but the only way we're going to get through the next five to 10 years is by retaining every possible member of staff we can.

"In the Central Belt - where you've got large hospitals and teams of 30 - you can smooth it out, but in small hospitals like my own or in the Highlands, Dumfries and Galloway, Ayrshire - the peripheries - you've got small teams, it's really difficult to recruit, and if you lose that one key consultant it can be the difference between a viable service and a service that collapses."

Dr Eunson said he also had a "very significant worry" that there will be exodus of young doctors to Australia and New Zealand now that the borders have re-opened, and where much lower rates of Covid over the past two years mean treatment backlogs have been minimised.

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In Scotland, the NHS re-mobilisation strategy is banking on the creation of a network of dedicated elective hubs capable of delivering an extra 40,000 planned procedures a year by 2025/26.

While welcoming the aim, Dr Eunson cautioned that risked "destabilising" acute care without a substantial increase in frontline staff.

The Scottish Government has set a target to recruit 1,500 new clinical and non-clinical staff for the National Treatment Centres by 2026.

"The worry is that this is going to be robbing Peter to pay Paul," said Dr Eunson.

"Without a fundamental increase in the number of people we've got, all you're going to do is take people who are working in very pressured district generals and move them into these hubs that offer a better working life."

The National Treatment Centres will be dedicated elective hubs

He stressed that hospitals are not "overwhelmed" by the total number of A&E attendances or admissions - which both remain below pre-pandemic levels - but because too many beds are being occupied by patients well enough to leave.

Dr Eunson said: "The whole system is clogged up because there's no space in social care, so the whole hospital is full of people who are delayed discharge which means there's no beds for the acutely unwell people, who then end up backed up in A&E, which in turn means the ambulances can't unload so then there's no ambulances to respond to the emergencies in the community.

"The whole system has ground to a halt, and every day you're swapping risks: the risk of someone being looked after in an A&E department when that's no the right place for them, versus the risk of moving them to an overstretched ward, versus the risk of discharging a patient sooner than they should be going home.

"These are the pressures we're seeing day to day, but the impact of that is that planned care is being kicked into the long grass, and if you're on an elective orthopaedic waiting list you're essentially going nowhere."

Total admissions (emergency and elective combined) remain below pre-pandemic levels, but delayed discharge in on the rise

He added: "I would be very nervous if I were someone needing health and social care right now, because the whole concept that the NHS will be there for you at the point of need is a bit shaky.

"It does feel like we're moving into a very two-tier system where if you can afford to pay you're probably going to get a better service: be that paying for your own social care because the council-run services aren't there or because you need an elective procedure and you end up paying for it because otherwise you'll be waiting four years.

"That's not the way it should be, but unfortunately I think we are going to end up with a twin-track system for quite some time."

The Scottish Government has stressed that NHS Scotland's workforce is at record levels and that it has ploughed "significant additional funding" into social care, including £62 million to enhance care at home capacity; £48 million to increase the hourly rate of pay; £40 million to provide interim care arrangements; and £20 million to enhance multi-disciplinary teams.

Funding is also being used to "rapidly scale up Hospital at Home" services.