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

Delivering the change our NHS needs – Jackie Baillie MSP

The founding of the National Health Service remains one of the Labour Party’s – and our nation’s – proudest and most important achievements. At its heart is the promise that if you are ill or have a serious accident, you will receive the care that you need – free at the point of use, whatever your background or circumstances.

It’s a matter of deep regret, therefore, that some 75 years on from the founding of our NHS, too many of our fellow citizens will rightly feel that this binding promise largely exists in theory only.

The reality facing patients in Scotland is stark – and a far cry from the aspirations of its post-war architects. At the time of writing: –

  • A staggering 824,725 Scots – that’s almost 1 in 6 – are on NHS waiting lists for tests and treatment. More shocking still, almost 83,000 of those waiting have done so for more than a year.
  • Cancer is Scotland’s biggest killer, with cases being predicted to rise by 22% in Scotland by 2040. Despite these warnings, the latest figures show that more than more than 1 in 4 patients waited longer than 62 days between urgent referral and treatment.
  • Thousands of children and young people are on waiting lists for mental health treatment.
  • Life expectancy in Scotland is declining and health inequalities are widening.
  • NHS staff feel overworked and undervalued trying to keep the system going which only exacerbates existing problems – over 5,300 vacancies are currently unfilled. 

Patients don’t need to be convinced of the calamitous state of services; they can see it every day in their own communities. Whether it’s the long waits in A&E or hanging on the phone desperate for an appointment at their GP surgery as they struggle to get through. At the same time, NHS staff on the frontline are bearing the brunt of decisions beyond their control. Doctors, nurses, and indeed all staff do not want to work in an NHS where they see patients being let down. Healthcare workers are burnt out and exhausted; many have already been lost to early retirement, whilst others are on the brink of handing in their notice.

The SNP have been in power for almost 17 years, and they must take responsibility for the mess that has unfolded on their watch. Unfortunately – and rather desperately, in my view – Humza Yousaf stands in the parliament chamber each week and peddles the myth that the pandemic is the sole cause of the NHS’s woes. This is simply untrue. It would be churlish, of course, to claim that the pandemic did not have a devastating impact on our healthcare system. The suggestion, however, that services were running smoothly before anyone had even heard of Covid is a fallacy. The facts speak for themselves. This SNP Government has not met its 62-day performance target for starting cancer treatment across Scotland since 2012, and the CAMHS target for 90% of children and young people to start treatment within 18 weeks of referral has never been met.

The pandemic was the lightning conductor which exposed a system already under pressure. The challenges across the NHS are not new, but they are certainly more acute now.

The recovery stage of the pandemic must be seen as a first step of generational reform; not just fixing the problem without confronting the challenges that have not been addressed since the Christie Commission report.[1] As Don Berwick, from the Institute of Healthcare Improvement, rightly says, “Fate will not create the new normal, choices will”.[2] As it stands, the SNP’s NHS Recovery Plan is delivering little more than broken promises and “whataboutery”.

There are, of course, some in society who believe that the NHS is no longer able to meet the needs of a growing population – one that is living longer and with comorbidities. I also hear it argued that the NHS will never be able to keep up with the pace and change of innovation in global healthcare. It was dismaying to hear that NHS Scotland chief executives had met behind closed doors and mooted the idea of a two-tier health service.[3]

I think they are wrong. I refuse to believe this is as good as it gets – the Labour Party created the NHS, and we will always fight for our NHS.

It is true, however that the status quo is not working – and more of the same simply will not cut it.

That’s why Scottish Labour is determined to transform the NHS to ensure it is fit for future generations.

We are calling for an NHS Recovery Plan that is community care-led, focuses on preventative healthcare and rewards staff. But how do we get there, and what do we need to do to lay the foundations of transformation?


Reforming NHS governance

More than a decade ago, Scottish Labour set out plans to reform the cluttered landscape of NHS bodies. The current system is top-heavy, bureaucratic and, quite frankly, is not delivering the standard of services that both patients and staff rightly expect and demand. Instead of operating as one NHS, barriers to co-operation and sharing of resource are the norm.

As it stands, Scotland – with a population of c.5.4 million – is served by 14 territorial health boards, 8 special boards, 3 regional planning bodies and 31 health and social care partnerships. This is excessive, inefficient and epitomizes the all-too-common problem with this SNP Government: the desperate need to create more layers of bureaucracy and governance in the hope of papering over cracks, rather than identifying the problems and offering solutions.

 
What is Scottish Labour’s alternative?

We want to reduce the number of territorial boards from 14 to 3 and will review the current number of special boards. In doing so, we will work with island and rural communities to ensure that any change to arrangements meet their specific needs. These reforms are about decentralising decision making. We need to drive improvement in primary care and align our governance structures with that priority. These reforms are also about delivering services closer to communities. This is what matters to patients.

Let me take, for instance, my constituents in Dumbarton. They do not care where their health board is headquartered. But they do care whether the clinicians and managers in the Vale of Leven Hospital are empowered to implement the service changes that patients need and want. Similarly, they want to be able to visit their GP surgery or health centre and access a range of services and treatments that can and should be delivered locally. By harnessing the opportunities offered by digital technology and ensuring that GP surgeries are staffed with the multidisciplinary teams needed, this can become a reality.

 

National Clinical Council

Reforming NHS decision-making must mean learning from mistakes. I meet with health professionals on a regular basis, and I’ve lost count of the number of times I hear them tell me that they feel like the government machine and powers-that-be do not listen to them. Scotland is facing an NHS workforce crisis, and this is only going to get worse unless there is a cultural change in how decisions are made.

At our conference, last month, I announced that a future Scottish Labour Government will establish a National Clinical Council – a statutory body that puts clinicians at the top table where they can use their skills, expertise, and knowledge to inform decision-making. This policy commitment will empower clinicians and health professionals and ensure that Ministers are being advised by the right people, who know what patients want and need.

Clinical Councils play a crucial role in healthcare systems across the world, and it is time that Scotland followed best practice. I am confident that by changing culture, it will allow for more informed policy decisions that improve services for patients and, in time, improve health outcomes.

This National Clinical Council would be tasked with advising Ministers on service delivery, workforce planning and patient safety. On the latter, no one can ignore the toxic culture of cover-up and secrecy we’ve witnessed after 17 years of SNP Government. The Council will be required to advise Ministers on patient safety and encourage a culture that is characterised by openness and accountability and supports whistle-blowers.

These changes alone will not fix the NHS, but they are critical steps in a journey of transformation. In the months to come we will set out our plans to transform primary care, to encourage innovation, to make the most of the skills and talents of NHS staff and to deliver improved health for the nation.

 

Conclusion

It’s not enough for the NHS to exist in name. We must aspire to better. The NHS must continue to meet the needs of patients and value its staff.

Scottish Labour have started the groundwork of setting out our vision for how we want the NHS to look in 2048. The NHS of tomorrow must be rooted in local communities, deliver better outcomes for patients and empower clinicians and staff. This is our mission for delivering the change our NHS needs.

Dame Jackie Baillie is the MSP for Dumbarton, Scottish Labour Deputy Leader and Spokesperson for Health and Social Care

[1] https://www.gov.scot/publications/commission-future-delivery-public-services/

[2] https://jamanetwork.com/journals/jama/fullarticle/2765699

[3] https://www.bbc.co.uk/news/uk-scotland-63659754

If you would like to contribute to Reform Scotland’s NHS 2048 forum, please email [email protected]

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