A Diagnosis and Treatment Plan

Without better workforce planning and expanded funding the prognosis for our NHS is dire, writes Wilma Brown.

The NHS is our most, quite possibly only, revered public institution. No other comes remotely close, and the golden nugget in there is the unwavering commitment of staff to deliver the very best care.

During the pandemic you will remember one reason for doing the decent thing of avoiding contact with others was “to protect the NHS”. It says a great deal about the status of the NHS that this was felt to be a useful slogan, given the role of the NHS to protect us. By way of comparison how successful would a lockdown predicated on “Stay home to help out Holyrood” have been?

This should not, though, be a cause for complacency – there is a well known phrase attributed to Bevan about folk having the faith to fight for the NHS. We are beginning to see more private interest and back door privatisation in the NHS which means we should at least be on our guard and be ready to fight for our NHS.

2022 saw a 73% increase in the number of people paying for surgery or intervention in the private sector. The vast bulk of these patients appear to be people using their savings or borrowing to seek a private medical intervention. These ‘self pay’ patients are in addition to those who are using private healthcare schemes through work, insurance or mutual policies, all to avoid languishing in pain in the ever-growing NHS queues.

In 2021-22 there was a 41% increase in the number of patient complaints with all indicators suggesting that the number will increase further from 35,172 to a figure much nearer 40,000. The majority of complaints appear to be related to waiting lists, although there are indications that complaints regarding how staff communicate with members of the public are also on the increase. That these two things could be related is a thought that crosses the mind of most people who examine the figures. Of course, we fail to count the millions of ‘thank yous’ that come in daily across NHS Scotland.

Staff of course can’t impact directly on waiting lists, but it seems that when it comes to explaining inadequacies, citing ‘COVID’ is less of the get-out-of-jail-free card than it was.

There is a tendency to downplay such figures because Scotland’s numbers are better than NHS England’s. This, though, is never an appropriate or acceptable defence. Even leaving aside that there are some indicators where Scotland isn’t better (generally around very long waits) it doesn’t cut much ice with patients. It doesn’t make the pain any less, or allow patients to go about their normal lives and accept the excuse.

There are challenges in Scotland’s NHS – most of them unrelated to the pandemic. This doesn’t mean that we accede to those who argue that the NHS is unsustainable. That argument is made with tedious regularity by Tories and market-loving think tanks. “Choice is difficult” is the mantra-like chant of those arguing we should choose a smaller NHS or one with more private involvement. They seldom spell out whose lives will become more difficult as a result of those choices.

The difficulties facing the NHS are less to do with structure and more to do with underfunding and inadequate workforce planning. Funding is starved on a day to day level, and the NHS also lacks the investment capacity to properly adapt and plan for the future. The debate we need is far more about resourcing and planning than structure, but neither should we set our faces against development and change, which is the only way forward.

There is no reason why our NHS should not continue to be both loved and free at the point of use 75 years from now. This will take big political decisions and long-term investment to underpin the modernisation programme, developed by those in the NHS and not by politicians, which Scots deserve.

The Scottish Government’s commitment to safe staffing in our NHS (due to be implemented in 2024) arguably suggests a commitment in Scotland that others could learn from. However, there is a growing degree of scepticism amongst NHS unions and workers. We have closely observed the lack of teeth this process has had in Wales, in making any difference in these dire times. The process outlined by the Health and Care Staffing (Scotland) Act is long on report writing but short on practical remedies. Staff are fearful that Health Boards and Scottish Government will simply continue to ignore staff concerns, press on with their current ‘nothing to see’ approach, and make the same old excuses.

The Scottish Government have, rightly, held themselves up as leaders in industrial relations, with not a day lost to strike action amongst NHS Scotland Agenda for Change workforce. That result was hard won. UNISON expects the Scottish Government to hold its end of the bargain and lead a reform process which improves workers’ pay, terms and conditions. This won’t solve the recruitment and retention crisis in our NHS by itself, but it is an essential step without which few other measures will have much relevance.

This is the real modernisation agenda in the NHS, but it is set against a backdrop of potential cuts to public service funding. We have NHS Boards unable to achieve financial break even in 2023, fuelling an alternative agenda for the future where Chief Executives and NHS leaders are actively lobbying to close beds and reduce services.

That is a prospect which we must contest, and we must do so by arguing for more resources for health. Resources must be raised not from raiding the budgets of other vital public services but from expanding the Scottish Government’s budget as a whole by using the powers Holyrood has to tax wealth. That is the ground the NHS faithful need to fight on.