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

Without urgent reform outlook for NHS is terminal

This article by Alison Payne first appeared in The Sun on 4 June 2024

Scotland’s health and care services are in crisis. Each day seems to bring yet another alarming headline. Only last week this newspaper highlighted an increase in waiting lists, a decline in the number of patients being dealt with in A&E within the four hour target and a decline in the number of Scots able to get a GP appointment within 48 hours.

But the issues facing the NHS and social care are not new.

While the pandemic undoubtedly exacerbated problems, the pressures from rising demands and costs, and growing gaps in the workforce, have been felt for many years. And, of course, the longer people spend waiting for intervention and treatment, the greater the risk that their health deteriorates. This leads to additional pressures on primary care and potentially more invasive interventions needed, all of which increase the risk of poorer outcomes for the individual, and greater expense to the NHS.

In other words, an ever decreasing cycle of decline.

It could be argued that the NHS is a victim of its own success – it is enabling us to live longer, healthier lives.  But as a result we have an aging population.

By 2045 we are projected to have a 65% increase in the number of people over 75 – many of whom will require increasing levels of health care.

At the same time our working-age populating is shrinking, which means a smaller taxpayer base to pay for these vital services.

In other words, without reform, the NHS is in danger of collapse.

Reform means restructure and prioritisation, it does not mean privatisation. Too often the political debate around the NHS in Scotland is a public versus private binary discussion. However, it is important to remember that the current structure of the NHS in Scotland relies heavily on the private sector, and always has – for example our GPs and pharmacists are independent contractors.

More money – which may not be possible- does not offer a magic wand. If we want to preserve the principle of an NHS that is free at the point of use for future generations then fresh thinking and open minds are required to consider a number of wide ranging issues.

Reform Scotland believes that Scotland urgently needs to have a mature, constructive debate to identify and build consensus around specific measures that will help our health and care services in both the short and long term. And we have to be honest with the electorate. Change cannot happen overnight, especially when crises are exacerbated by staff shortages and growing waiting times.

Reform, if implemented properly, will need to be multi-disciplinary, require joint working and cross-party buy-in and likely take more than one electoral cycle.

There are a number of key themes that will need to be considered.

We need to prioritise prevention. Alcohol, smoking, drug use and obesity are huge societal health problems and contribute to Scots dying younger than in any other Western European Country.

We need to embrace technology – not just in treatment and diagnosis but basics such as giving patients more control. The NHS in England has developed an app, which enables users to order repeat prescriptions, book appointments, and view personal health information. The app has more than 33 million users. No such system exists in Scotland.

We need to consider what services should be organised and delivered more directly within communities, and where it makes more sense for a broader approach.

There are also wider challenges which impact on healthcare delivery, such as attracting and retaining workers in more rural areas as well as recognising the health impacts of poverty and poor housing.

And there can be no sustainable future for the NHS without addressing problems in social care. There are no easy answers and many touch choices lay ahead. Politicians need to come together and be honest with the electorate about the scale of the challenge. No one person or party is to blame for the problems being faced. Only by looking to the longer term and working together to enable reform can we preserve our NHS so that it might reach its centenary.