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

Reform is a must to fix NHS crisis

This article by Alison Payne first appeared in The Sunday Times on 27 November 2022

The NHS is in crisis. Each day brings another alarming headline. Audit Scotland has talked of our health service being “unsustainable”, with senior managers reportedly so concerned they discussed the potential of a “two-tier” system where the richest pay.

But the issues the NHS is facing are not new. Although Covid clearly exacerbated problems, the pressures from rising demand and costs have been felt for years. Scotland has an ageing population, those problems will only worsen.

More money, which we don’t have, does not offer a magic cure. Radical reform is required to keep the principle of healthcare free at the point of use.

We also must be honest and accept that the very basis of the NHS relies on a functioning private sector: our GPs, pharmacists, opticians and dentists are key and all private sector contractors.

There are undoubtedly some limited opportunities to identify savings. Do we need four specialist trauma centres when an evaluation said that Scotland needed one or two? An eye test in Boots in England costs about £25. Should taxpayers be spending £14 million each year to pay for those who could pay for it themselves? Dental check-ups are free, but only if you can find a dentist taking NHS patients. Will the National Care Service, the fourth attempt at integrating health and social care since devolution, improve matters?

Centres of excellence for routine operations and specialisms work well where practitioners and teams can build up skills. But it is equally important to have local integrated teams. Lessons can be learnt from Nairn, where the GP practice still provides out-of-hours care, works alongside community hospital nurses and makes use of shared facilities with social care.

An NHS that focuses on fire-fighting stores up future problems. Free prescriptions are a useful preventative spending measure and help encourage early intervention.

If people put off going to the GP or can’t get an appointment, or languish on waiting lists, their problems only increase, their potential recovery can worsen and their cost to the NHS rises.

More early intervention is needed. Holyrood expanded the use of minor ailment services during Covid, but could pharmacies work with nurse practitioners? Can we use technology better? NHS NearMe is a good example but our NHS still uses faxes.

We need the courage to try different things and to learn from experiences — successful or not — in Scotland and elsewhere. If we don’t try new things soon, we may not have an NHS left to reform.