How do we fix Scotland's NHS? This could be the start

Down the intervening decades, it has become totemic, particularly in politics, to praise the NHS. Is it not wonderful? Is it not glorious? Faith in the health service is the closest we have to a shared religion. We still, rightly, laud the remarkable endeavours of medical, nursing and support staff. Many strive well beyond the allocated call of duty.

And yet. We still, rightly, rely upon the NHS to cosset us if our health is failing, to address our medical and surgical needs.

And yet. The system established in 1948 – or 1913 – is no longer fit for its much expanded purpose.

It is not solely or even primarily a question of money. Demand has utterly outstripped supply and the provision of care is inefficient. The NHS is, perhaps, not completely broken. But it is certainly badly bruised. It requires careful, considered attention.

The NHS was once the pride of Britain (Image: free)

Significantly, that opinion is shared by Audit Scotland which warned recently that the NHS, as presently constituted, was unable to cope. Further, public satisfaction has declined.

In the British Social Attitudes Survey, covering 2023, just 24 per cent of respondents said they were satisfied with the health service. The figure in 2010 was 70 per cent. For all that we thank and praise individual staff for their care and attention, for all that we are grateful and relieved, we are far from content, overall. It will not do. Things must change.

Neil Gray, Scotland’s new Health Secretary, is thinking along such lines. I would expect him to launch a Holyrood discourse about reform mid-May, perhaps accompanied by a set-piece event outside Parliament.

His starting point will be that he is open to all ideas – with two provisos. NHS Scotland must remain a public and publicly owned service; and one which is free at the point of use.

In this, he is building upon a little-noticed section of Shona Robison’s Budget speech in which she explicitly linked investment to public service reform, orchestrated by what she called “a National Conversation to help shape the NHS for the future.”

I think it possible that Mr Gray may be somewhat more open to collegiate working than his immediate predecessor, Michael Matheson. I believe Mr Gray wants to work with stakeholders, including staff – and, if possible, other parties. Ms Robison perhaps eased the way to co-operating with the workforce by promising no compulsory redundancies.

But there are limits. Partisan politics is combative. Labour’s entire approach, for example, is founded upon offering “change”. Labour-led change. At Westminster, and eventually at Holyrood.

However, let us be clear about another point. Problems with the NHS are not confined to Scotland. There are challenges in England, where health is governed by the Conservatives. And in Labour-run Wales. Whoever is in charge, in whichever administration, is going to have to face the fact that the NHS is not working. The arithmetic does not add up.

People are, generally, living longer. There are more and more medical treatments, more and more pharmaceutical solutions. All at a huge cost.

To tackle the underlying, structural problems, we need to enhance productivity – and reduce demand. Efforts are under way in Scotland. Only this week, we witnessed a new system of staff planning. We noted the first £30m tranche of funding designed to cut waiting times, with the objective of tackling backlogs and cutting lists by 100,000 over three years. But it is nowhere near enough, as Opposition parties justifiably stress. We need more.

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Mr Gray’s first official visit in his new post was to a Flow Navigation Centre (FNC) in Glasgow, a virtual service designed to direct people to the most appropriate care. And, guess what, that was seldom our hard-pressed A&E service. Even though it may be instinctively the first thought of most citizens. Of 20,000 calls placed with the FNC, only 16 per cent justified a trip to casualty.

I recently discussed this point with a senior A&E doctor – who wearily confirmed this diagnosis. So we need to find other ways to stem unwarranted demand without deterring patients who genuinely need urgent care.

This will be far from easy and will require the collaborative approach which is the core of the review signalled by the Minister.

More, we need enhanced productivity. Greater use of robotics, where feasible. Scotland is said to be developing an advantage in this field. Greater use of AI. A more flexible use of clinical and surgical resources. All of which may require new ways of working. And we need to free space in our hospitals. Which will require an improvement in care so that patients can safely be discharged.

I am unconvinced by the proposed National Care Service. My fear is that it will generate a substantial bureaucracy – when we need more staff in care homes and on domestic visits.

Then there is the biggest challenge of them all. Preventing ill health. Paul Johnston, the Chief Executive of Public Health Scotland, recently pointed out that health boards spend £2.3bn dealing with the impact of poverty. He cited various campaigns, including alcohol pricing, as evidence that public policy can be altered to improve health. He argued for much more in that direction.

That challenge will confront us. All of us. Regardless of which party wields power at Holyrood or Westminster. For it is a collective challenge. I think it remains generally accepted, particularly in Scotland, that we want a public health service free at the point of need, with no care penalties for poverty. But I believe we require, together, to redefine need. Genuine need. Not unthinking or habitual demand. Without recreating obstacles to treatment.

Who said it was easy?