NEIL MACKAY'S BIG READ: The Scottish NHS is collapsing ... but are doctors right in blaming the SNP?

The Herald on Sunday invited Dr Julia Patterson, founder of EveryDoctor – the 1,500-strong doctor-led campaign fighting “for a better NHS” – and her Scottish counterpart, Dr Maria Corretge, to debate the state of our healthcare system. Patterson speaks for the UK and England, and Corretge, a consultant in West Lothian, speaks for Scotland.

Their assessment is utterly damning: the NHS is collapsing and may not survive; patient care is suffering profoundly; doctors are unable to offer the care they want, leading to unnecessary deaths; and political mismanagement is killing people.

There are comparisons with “developing countries”, even war zones. It has emerged one Scottish patient waited 84 hours for treatment in A&E.

Crisis point
CORRETGE begins: “We’ve reached crisis point. There’s no adult conversation about how to save the NHS. Patients are suffering. Outcomes in Scotland aren’t good. I chuckle when people talk about ‘excellent care’ because we don’t provide that.”

Corretge is a geriatrician, originally from Spain. “It’s very sad. When I arrived 20 years ago, care was quite good – now it’s not good. Waiting times for cancer and elective procedures are scandalous. Treatment for stroke is substandard. We’re letting down the most vulnerable.”

Dr Maria Corretge, (Image: Dr Maria Corretge,)

The Scottish Government isn’t “transparent”. The public “just doesn’t know” how bad it has become. “In my patch there have been bed closures and no noise about it.” One West Lothian hospital, St Michael’s, faces permanent closure, but “there’s no drama”.

Such losses, she says, “explain A&E queues”, adding: “It doesn’t take much to break the camel’s back now. The system is working at above 100 per cent capacity.”

Doctors now “discharge as many people as they can. If you don’t discharge, then somebody will be waiting extra hours in A&E. There’s no give in the system”.

Scotland’s drug death rate is much worse than England’s. But what really troubles Corretge is that in England “there’s loads of noise” about NHS decline, and calls for “government to do better. I don’t see that in Scotland”.

The indy problem
CORRETGE believes those most likely to complain – young left-wingers – “have been captured by independence”. She adds: “They don’t want to be critical of government. We’ve a pro-independence movement but nobody protesting saying ‘this is terrible’.”

Independence supporters fear being seen as “lesser patriots” if they criticise the SNP. “Public debate has been kidnapped by independence. That’s a useful way of hiding things under the carpet.”

Patterson says England’s NHS has lost “almost 10% of its workforce – the worst it’s ever been. There’s 6.7 million on waiting lists.

Ambulance waiting times are terrifying … We’re going into winter in a really scary state. The NHS has never been under more pressure”. Pay has fallen. Staff morale is low. The “right-wing press” scapegoats GPs.

It’s “misrepresentation”, she says.

“Simultaneously, the [UK] Government allows GP surgeries to be bought by American health insurance companies. None of this is being articulated to the public.”

Corretge is “seething” with Scottish Health Secretary Humza Yousaf. “Trust in him? Zero,” she says. “There’s no plan, no strategy.” SNP health policy is “vacuous”. Government in England and Scotland “avoid the massive problems that have eroded medicine in the last 20 years, and haven’t even apologised or acknowledged past mistakes such as reducing bed capacity”.

When it comes to bureaucracy, too often decisions are taken by non-medical staff – “somebody not well versed” in what local communities need. The result? “Patients suffer.”

In Europe, where Corretge practised, “there’s very strong, very good and better public healthcare services”. One major problem is that “elderly people are very isolated. They need care and there’s no discussion how to pay for this. The care sector is deeply part of the problems we’re seeing in the NHS”.

She adds: “We’re not providing excellent care – we’re providing very mediocre care and patients are suffering. Yet I don’t think anybody is acknowledging that in Scotland. We’re all ‘oh, we love our NHS, you’re all heroes’. But we must talk about difficult things.”

Privatisation
PATTERSON says there must be “an honest conversation about what people want”. Privatisation is happening but “it’s not reported. It’s really dishonest. Scotland now has dynamic purchasing systems similar to what’s happening in England. Bits of the NHS are starting to be privatised in Scotland, mirroring what’s happening in England. Private companies are infiltrating the Scottish NHS just like in England – although it is in its infancy in Scotland”.

Dr Julia Patterson (Image: Dr Julia Patterson)

She adds: “This outsourcing is happening and people aren’t aware. The NHS is getting worse and worse and privatisation is part of the reason. Everything should be laid on the table: this is how much privatisation there is, how much money there is. We need to have those debates and find a way forward. If we continue along this trajectory of privatisation by stealth, the NHS will just become a logo.”

Corretge says NHS staff are increasingly quitting as they’re overworked and underpaid. “It’s a pressure cooker.” When she was a junior doctor, Corretge worked 12 days straight with two days off. Staff aren’t doing that anymore. “People aren’t going to prop this up with goodwill anymore.”

Doctors are ground down. With staff leaving, “those who remain carry greater loads. The workforce has lost its stability. People are thinking ‘how much of myself am I meant to give to this career?’.” There is a lot of “burnout and stress” and there are simply not enough GPs available to promptly see every patient requiring help.

Blame for that doesn’t lie with GPs but politicians. “There’s a really old-fashioned attitude towards doctors,” Patterson adds, where they are expected to work harder than other professions.

Traditionally, doctors worked exhausting hours because “that made a difference”, Corretge said. Now, however, doctors feel they “don’t really make a difference because it doesn’t matter how hard you work – if patients don’t have beds and are going to wait in A&E for 24 hours, we’re not seeing a difference”.

English comparison
CORRETGE adds: “Waiting times for cancer are longer in Scotland than England, waiting times for some orthopaedic procedures are longer too. Then there’s the drug death scandal – we do so poorly compared to England, and they’re not great.” Again, Corretge questions why young left-wingers “aren’t making a noise about this. Nobody is outraged”.

She says that clot retrieval, “the new procedure to save people from developing full stroke, is magic”, adding: “It has such great outcomes yet it’s not fully established in Scotland whereas it’s in most of England. I always say, ‘if you’ve a stroke in the borders, go south’.”
Clot retrieval is slow in Scotland as “we don’t have enough radiologists. When Nicola Sturgeon was health minster she cut places in medical schools. There was very poor workforce planning. Mistakes were made and now our outcomes aren’t good – 24-hour waits in A&E are now normal”. Once patients have been seen in A&E, if they need admitted “there’s nowhere for them to go”. She adds: “It is heartbreaking. You’ve very elderly, frail people sleeping in A&E as there aren’t beds for them.”

Deaths on trolleys
PATTERSON points to recent Royal College of Emergency Medicine (RCEM) figures showing that more than 4,500 patients died in England after waiting 12 hours on trolleys. RCME also found hundreds of patients died unnecessarily in Scotland because of A&E delays.

“Ambulance times are too long,” Patterson says. This and the fact that “you’re having to wait 24 hours for somebody to initiate your treatment is going to cause deterioration which will probably lead to some deaths”.

Corretge turns to “boarding” patients – moving patients around wards to free up beds. “We already knew before 24-hour waits were normal that boarding patients increases the length of stay in hospital.” It also increases risk of delirium for the elderly. “For someone with just a few years left, that’s awful. 

“Everybody can see people suffering. You’ve 90-year-olds sleeping on trolleys – of course that’s harmful. It breaks your heart.”

Politicians blamed
SO, are political decisions killing people? “Yes,” says Patterson. “Decisions have led to people dying. People are dying who don’t need to die because we’ve massive waiting lists – people are waiting 24 hours in A&E. Health outcomes have deteriorated because politicians have ignored calls to strengthen the workforce. Healthcare delivery is failing. To make a difference: shore up the workforce. Government has chosen not to do that so they must take responsibility for the state of healthcare.”

Does that apply in Scotland, too? “One hundred per cent yes,” says Corretge. “There’s a will to hide things and stop the public from knowing what’s happening in the NHS. Is that harmful to patients? Yes … There’s been mistakes that haven’t been acknowledged because of the political shame. Fair enough, hide your mistakes for other things, but this is real people impacted by these mistakes.”

She adds: “Since the 2000s, the Scottish NHS has deteriorated. We were talking about a geriatric tsunami from 2001. Instead of increasing bed capacity, it’s decreased. Instead of expanding the workforce, they decreased it. There’s been so many mistakes. But they aren’t discussed. When privatisation happens, nobody mentions it.”

British doctors, she says, are superb. “I’d choose British doctors over anybody. Yet our outcomes are worse than other places.” That’s down to politicians making “fundamental mistakes”.

Patterson adds: “It’s happened because politicians made certain decisions. They’ve not valued healthcare workers.” Pay for healthcare professionals has fallen in real terms. Corretge says that when she came here 20 years ago, she earned more than her “peers back in Spain. Now I don’t”.

Should running the NHS be left to medics? Patterson replies: “Studies show when doctors have greater roles within healthcare, there’s better patient outcomes.” Corretge fears the proposed creation of a Scottish National Care System, as the SNP has “failed so badly” in running the NHS.

Winter is coming
CAN the NHS continue like this? “No,” says Corretge. “It’ll continue to get worse unless people do something really quickly. There’s no plan. What’ll happen? Will we have 48-hour waits in A&E? I’m very fearful of this winter. In 2008 [during the last economic crash], elderly people were dying of hypothermia as they couldn’t heat their houses. We’ll see that again but this time they won’t be on wards [getting treatment], they’ll be on trolleys in A&E. It’ll be worse.”

Corretge predicts increasing use of private healthcare. So are we heading for a two-tier system? “We’ve one already,” she says. Patterson agrees: “And it’s getting worse.” She believes the English NHS will become a “cash cow, publicly funded but providing a constant source of income for US companies. Standards will worsen unless something drastic is done”.

Governments make “poor decisions” when it comes to NHS spending like paying “external consultancy firms an absolute fortune”. Corretge says politicians go for “dazzling shiny things” rather than what’s really needed. “Money gets wasted that won’t impact patients … Vulnerable patients must be the ones benefiting from our taxes. We’ve so many new systems – for this, for that, blah blah blah – but there’s more important things.”

There’s a crucial difference, Corretge says, between paying for private healthcare “for convenience, and paying out of necessity”. People are free to go private for convenience, but going private out of necessity “is just wrong”. Back in Spain, “the Spanish NHS would always be there” for patients. “I don’t think we can say that anymore in Scotland. It’s tragic.”

Exhausted GPs
PATTERSON feels it’s “convenient for government to blame Covid” for longstanding problems in the NHS when one of the central issues is “we just don’t have enough GPs”. GPs are quitting due to overwork and stress. “GPs often have only seven minutes with patients … The idea GPs can absorb all this as the system becomes more under pressure is crazy.”

Corretge says GPs just about manage to keep their heads above water. They have huge ranges of patients to deal with, and even after seven-minute consultations must spend more time addressing follow-up treatment, hospital appointments and tests. “People don’t appreciate how much work they do.” The public has “internalised the GP-bashing” narrative and now blame GPs rather than politicians – sometimes even abusing them in surgeries.

Phone consultations are “a waste of time” as doctors “can’t advise patients” properly. “So much communication is non-verbal,” she says. Doctors need to physically see patients. Speaking to patients by phone is like “creating paediatric hospitals without toys”.

Ambulance chaos
AMBULANCE times are chaotic because of “bed blockers” – a “horrible term”, says Patterson, for elderly patients “who don’t need to be in beds” but are unable to be discharged due to lack of care. The knock-on effect means patients in A&E can’t be moved onto wards – so A&E fills up. Then ambulances are stuck in bays unable to hand patients over to A&E.

“We’ve got the ridiculous situation where some consultants spend their entire shift looking after patients in ambulances as they can’t get patients into A&E.” That means there are fewer ambulances on the road and so delays mount. “This should be seen as an absolute emergency.”

With winter coming “it’s really scary. What’s the tipping point going to be?”.

Corretge says doctors often feel they are “offering second-best care as if they wait for what they should get for patients – even in a developing country – they aren’t going to get it. We’re settling for things that aren’t the best care”.

She says colleagues who worked in South Africa or war zones say “there’s no difference” in Scotland. “I don’t want to exaggerate. It’s not always like that. But if we’re saying ‘can the NHS survive’, well no, it really can’t.” The Government is just patching up problems. “There’s so much that could be done if we just talked frankly.”

Patterson says it’s “heartbreaking” that medical science is so far advanced but “clinicians can’t deliver the gold standard care we want to keep people safe. Doctors aren’t able to deliver the first-class treatment learned at medical school. That’s very wrong. But clinicians have become the scapegoats.” When care can’t be given properly, it’s doctors who “potentially lose their licence”. That’s another reason doctors quit. “They can’t tolerate it anymore. It’s unbearable.”

Developing nation?
COMPARISONS with developing countries may not go far enough, however. “We can’t be smug,” says Corretge. “With the resources some developing countries have, they do amazing stuff that I don’t think we’d be able to do. We’re not offering excellent care.”

Patterson says that with doctors leaving the profession she’s at a loss how the Government will solve operation delays. “That’s terrible for people.” Delays mean “worse health outcomes”.

Corretge adds: “Cancellations are because surgical beds are being used for patients being boarded. So fixing the care system is the most important thing.”

She explained that if patients, for example, were suspected of having pancreatic cancer they would “wait at least two weeks to be discussed by the local team”, adding: “They would wait another two weeks to get diagnostic tests. It would usually take three months to get the treatment they needed. Is that costing lives? It’s costing humongous amounts of quality of life.”

Mortality will peak
Corretge fears “mortality will peak” this winter. “Standards will fall.” Doctors will be forced to make difficult decisions to free up beds and get patients “out the door quickly”. She expects more staff burnout. Both are incensed by nurses depending “on foodbanks”. Patterson says “it’s absolutely appalling. Your own staff can’t feed themselves”. In 2017, the Red Cross warned of a humanitarian crisis in Britain due to pressure on the NHS.

She says: “I suspect we might get into similar territory. Things aren’t getting better. It’s already at breaking point.”
Would they be confident using the NHS? Corretge says she’d “absolutely” trust British doctors. “But would I trust the ambulance to come in time? Absolutely not.”

Patterson says: “If I’d a vulnerable relative who needed an ambulance I’d be hugely concerned.”
One of the biggest roadblocks is the media. It “gaslights” doctors, Patterson says, “insinuating we’re greedy and lazy”, and vilifies overwhelmed GPs. Doctors who complain are accused of “hysteria - but it’s common sense, of course people are having worse outcomes”.

Corretge adds simply: “The media has been awful.”