Scotland’s independent think tank
Scotland’s independent think tank

What does the NHS in Scotland look like after the pandemic? – Miles Briggs

We all know better than to start talking yet about life after the coronavirus: until it dies out or there’s a vaccine, we’ll be managing it. This is going to be a long haul.

But we are coming out of lockdown. The first peak has passed. People can start to process what’s happened. Politicians now have a bit more time and space to start thinking about what life now looks like. 

What could the future hold? Reflecting on the past few months, what should come next?

We should start with two fundamental areas: funding, and staff.

Right now, it’s impossible to put a number on the NHS’ funding needs – we just don’t yet know how it will emerge from the crisis, or indeed the wider shape of government finances. But it’s clear that not only will the public expect services to be properly funded, we will also have to return to the long-standing challenges of ageing and health inflation, too. A care backlog has built up, that will put pressure on the NHS this winter. The direction is clear: we will have to put health and care on a sustainable footing.

On staff, it’s not surprising that people took to the streets to clap for front-line professionals. They have always been the beating heart of the NHS, and families will long remember the dedication and compassion shown to their loved ones. It’s also telling that part of the message to the public was to ‘protect the NHS’ – it is an institution that we all want to do our bit to sustain. 

But all the scandals that dogged NHS Scotland before Covid19 – the Edinburgh Sick Kids, the QEUH, bullying at NHS Highland, preventable deaths at Crosshouses – have the same theme, which is that front-line staff are often let down by the wider systems in which they have to work. So often, the pattern is that professionals have their vocational drive gradually worn down by poor management, political drift, and relentless workload. 

There are three big things we could do to turn that around. There are some basic improvements we could make, such as a range of mental health, working conditions and workplace support that the Scottish Conservatives set out in our ‘care for our carers’ publication last year. That support feels even more urgent in light of the pandemic.

Second, we can make clinical leadership the norm. Jason Leitch has become a household name because of his ability to communicate with clarity and authority as a doctor and leader. But as a rule, in the NHS, the top roles tend to be taken by non-clinical managers. That’s not to slight them – we need good managers, too. There’s a balance, though, and at the moment, often the clinicians best-placed to lead the NHS can’t call the shots, particularly at the level of hospitals and Boards.  Making clinical leadership the norm across the NHS would change that. 

Third, Scotland should focus on redoubling its reputation as a centre for medical education. It looks likely that global movement of healthcare staff will take at least a short-term hit. We don’t yet know, but this could even be a permanent change. So rooting our NHS in teaching and research not only plays to our existing strengths, it is also part of a long-term solution to chronic staffing needs. The Scottish Conservatives have previously proposed a new medical school in Inverness, and we should start thinking about creating new routes into the NHS, too, like specific career-change programmes for people coming from other backgrounds. 

 Funding and staff are the first steps. But we’ve also seen how the systems that support the front-line can improve, too.

We’ve been talking about e-medicine, virtual consultations and telephone triage for GPs for years. Suddenly, it actually happened, because of the all-important need to identify patients with Covid-19.

But at the same time, the SNP’s record on testing is utterly woeful. PPE supplies took far too long to get up and running, as procurement systems were complex and inefficient at tapping up manufacturers.

The lesson of both these successes and failures is that we should think about how to make the NHS better at adopting new ideas and technologies. Scotland has an impressive biosciences and medical engineering sector. We have world-class universities. We have a budding tech scene. If we can create a much greater culture of collaboration between these institutions and the NHS, we can make the NHS smarter, more adaptive and faster. 

Even within the health and care system, we need better coordination. Care homes were the central scandal of the pandemic. They often felt like second-class citizens, falling between the cracks of the NHS, central government, and local authorities. We’re supposed to have integrated health and care system in Scotland, but the crisis exposed that too often, the different bits of the system didn’t join up. Fixing that has to be a priority. 

So, too, is better leadership from the top. The pandemic made the whole system face a single challenge, with the full backing of other parts of government, and with massive public support. But that only showed up the lack of political grip in recent years: isn’t it obvious now that the SNP lacked a sense of direction before? 

We have to avoid the days of drift coming back. We need a sense of overall mission. 

That means a big decision about the virus itself – and what kind of care we think is the new normal. 

Pandemics were on the radar in Scotland, but most policy and political attention was based on a completely different set of priorities. The central challenge was considered to be ageing, lifestyle conditions and chronic care. So since about 2005, the rough direction of travel was to reduce beds and put them in fewer, bigger hospitals, push care out into the community, and try and get GPs, pharmacists and social care linked up to relieve the pressure on acute hospitals. It lost momentum in recent years, and really the SNP were running on policy ideas developed a decade ago. But this type of thinking was still predominant.

 It was all based on a particular type of medical challenge – chronic, relatively predictable, often best addressed out of hospital, and which could be treated (if not prevented) largely by the health and social care system.

The coronavirus is the opposite: it was a new, unpredictable virus, requiring hospital care, at short notice, with a massive wider economic and social effort to avoid overwhelming the NHS. 

These are very different styles of care. So perhaps the single biggest question now is how to balance them.

The answer will likely be picking up the threads of pre-virus care, but with the ability to quickly ramp up the system to tackle big, sudden challenges. We can learn the lessons of this pandemic and if we retain the institutional memory, know what to do next time. But in the meantime, we have to build on the ideas of getting patients into the right kind of setting, with stronger community care, GP care restored, and increased focus on chronic care.

We might, after the peak of the pandemic, never think about our health in the same way again. Thousands of people have had their lives changed forever. We’ve seen the very best of health and care staff these past few weeks. If we can tap their energy and give them the resources they need, build a more nimble and responsive system around them, then we can build an NHS which can steer us through an uncertain world. 

This might not be the last pandemic to hit us. It’s also not going to change big, long-term demographic trends. Let’s not miss the moment to prepare for both.

Miles Briggs is a Conservative MSP for the Lothians and the Shadow
Cabinet Secretary for Health & Sport.