Surgeon leader: Other NHS funding models 'worth debating'

Although Prof Parks said he would not rule out controversial suggestions such as asking wealthier patients to contribute to the cost of treatment, he stressed that this would “need much wider debate” and he “would not take a view until I’ve heard from those who have proposed it or understand more about it”.

READ MORE: Is two-tier healthcare now inevitable?

Leaked minutes from a meeting of health board directors sparked an outcry last week when it was revealed that some had touted the idea of adopting a ‘two-tier’ system, where the more affluent are asked to pay for NHS operations, as a way of reforming the cash-strapped service.

First Minister Nicola Sturgeon said an SNP-led Scottish Government would never resort to such an arrangement.

However, the row has sparked interest in whether alternative funding models should be considered.

Prof Parks, a pancreatic surgeon, professor of surgical sciences and former deputy director of medicine for NHS Eduction for Scotland (NES) - which oversees medical training - said: “I still think that our NHS in Scotland is second to none for the whole population need.

"Yes, you can go to the States, Hong Kong, to big centres in China, and you see state-of-the-art delivery - but that’s not delivered across their entire population.

“I think it’s always worth having a debate. One of the privileges I’ve had from travelling around the world is having those conversations - maybe not with politicians and senior managers - but with clinical and surgical colleagues.

“There should be ongoing discussion about what other models could considered - I don’t shy away from that debate - but I’ve always come back to the view that the NHS delivers care in a very good way.

“I’ve got clinical colleagues who’ve gone to places like the Middle East or America to work for a while and then become disillusioned because of how they’ve seen things done.”

Prof Parks - who was acting medical director of NES during the pandemic - added that he did not recognise suggestions in the leaked minutes of a “disconnect” between the Government and its clinical advisors.

“That’s not been my experience,” said Prof Parks. “My experience is that the clinical voice is listened to.”

Prof Parks takes leadership of the RCSE at a time when the number of people on waiting lists for an elective procedure in Scotland has nearly doubled, from around 77,000 before the pandemic to nearly 140,000 by the end of June this year.

The next set of statistics, setting out the position as of September 30, will be published today.

READ MORE: Key targets omitted from Scotland's NHS Recovery Plan 

Prof Parks said the creation of dedicated elective hubs, separate from the major acute hospitals, would “help enormously” to clear the backlogs by ensuring that staff, beds and theatre space were not “constantly pulled away” to deal with emergency admissions.

However, in the short-term he said patients’ surgeries must be prioritised on the basis of need rather than a drive to cut waiting list numbers as quickly as possible by doing lots of simpler operations.

Prof Parks said: “Getting through a lot of the high volume, low complexity work will be one aspect of [clearing the backlog], but there also has to be some prioritisation of need.

“It’s relatively easy to say cancer patients should be prioritised, but there are also patients who have non-malignant, non-cancerous diagnoses whose quality of life is significantly impaired by disability and pain.

"I know from my orthopaedic colleagues that is a major issue.

“It comes back to the ‘clinical voice’ - the clinical voice will be very important when it comes to prioritising patients based on need, as opposed to what might be just a way of getting the numbers down.”

Official statistics indicate that around 7 per cent of consultant posts in NHS Scotland are vacant (Image: TURAS)

Prof Parks said his “major focus” would also be on training, recruitment, and retention, with pay and conditions "repeatedly" raised as an issue by College members.

Doctors and dentists UK-wide have been awarded a 4.5 per cent pay deal which has been branded a “brutal pay cut” by the BMA.

However, no decision has yet been taken on whether to ballot consultants in Scotland for industrial action.

There is also anger over “punitive” pension taxes which are spurring some senior clinicians to reduce their hours or retire early.

READ MORE: Why doctors are angry about their 4.5 per cent 'pay rise'

In July this year, a damning report by Westminster’s Health Select Committee - chaired by now-Chancellor Jeremy Hunt - branded the situation a “national scandal”and called for “urgent action” by Government to reform NHS pensions “to prevent the haemorrhage of senior staff”.

However, Mr Hunt’s autumn statement failed to address the issue.

Prof Parks said making elective surgical hubs a reality would require a combination of “new recruitment and thinking a lot about retention of staff who would otherwise be leaving”.

He said doctors in their 50s and 60s could be persuaded to stay on longer if they could reduce “arduous frontline and on-call commitments”, but added that there is also a fear many younger doctors could drop out.

“Morale has been low coming out of the pandemic,” said Prof Parks. “There is a perception that some of our trainees will leave and go overseas and therefore be lost to the workforce.

“That’s not a new thing. I did some work five or six years ago looking at the patterns UK-wide and, yes, there is a proportion of junior doctors who leave at the end of foundation training.

"They usually go away for one or at most two years, but because we can track them using their GMC number we know that 85-90% of them, at least historically, came back again.

“During the pandemic, all that dried up. Now, from talking to my junior colleagues and watching what they’re saying on social media, I suspect some of them will step out.

"It will remain to be seen whether they come back.”

READ MORE: What's the point of NHS targets when most of them haven't been achieved in years?

However, Prof Parks stressed that statistics also show an “opposite trend” of applications for doctor training posts in the NHS increasing year-on-year from a mixture of UK and international candidates.

He said: “We’re starting to see the benefit of additional medical student numbers that went in five or six years ago.

"Those students are now starting to graduate, so that is increasing the number of ‘domestic’ applicants for training posts.

“What we’ve also seen, because of change in immigration regulations, is an increase in international applicants.

“Pleasingly, the applications for 2023 training posts are increasing and that’s gone up year on year over the last few years - despite the pandemic.”

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