I am going to be a tad self-indulgent in this article, so get your violins at the ready because I’m going to tell you about the ‘good old days’ as a medical laboratory technologist. How a career in science was launched, back in the 1970s, and why it might not be such a bad idea to revert to successful training models in the Scottish Health Service, including those in primary care, which existed decades ago.
Back in the 70s, I embarked on a journey of discovery which has sustained me throughout my adult life. That is not an understatement… science and innovation is what keeps me sane.
Picture the scene – a gaggle of hippy-era late teens descend on a hospital training lab, resplendent in lightly starched, Persil-white lab coats buttoned right up under their chins, itching to get their hands on what would become the ‘tools of their trade’. The varnished, heavy wood surfaces of the lab benches beckoned, the slight whiff of stale formaldehyde – an aroma that provided the ‘Ah…Bisto’ element for those young trainee technicians eager to learn skills which would assist fellow medical professionals in protecting and caring for real people.
Lecturers ranged from senior laboratory scientists to professors who taught us the theory and practical skills needed in every medical laboratory discipline. We had to be well-equipped so we could be seconded to any lab within the hospital, if required. So we studied haematology, clinical pathology, medical microbiology, blood typing/transfusion and histopathology. We worked in our labs most days and attended day release classes for further training, and were taught additional practical skills in the evenings. It was full-on skill attainment back then! The job was interesting, time-consuming but fun, and the camaraderie and a sense of common purpose kept us all motivated to achieve high standards in our work.
Private sector is not the solution to public cuts
Fast forward to the present day, when the HNC medical laboratory technologists have been replaced by degree-holding biomedical scientists who tend to specialise in one lab discipline. It is important to note that salaries haven’t changed much although conditions have. In Scotland, shortages and reduced availability of trained staff has led to contracting out healthcare services to private companies. Ironically, many/most lab staff in these private companies were trained in NHS hospital labs in much the same way as private consultants and surgeons trained in the NHS – all frequently supplying consultations, treatment and surgery in private hospitals.
Lab analysis such as pathology and blood analysis are not the only service being outsourced to private companies. Analysis of CT and/or radiography scans, admin services, pathology, blood analysis, provision of facilities, theatre and equipment can be, and often are, outsourced to private companies. eg. InHealth, a company which operates Cardiac Cath labs in Scotland, is the largest provider of outsourced NHS services in the UK, with a reported annual revenue of almost £146.3mn in 2021, up from £124mn in 2020. The company’s profit was almost £11.4mn in 2021, up from £6.6mn in 2020.
Another arm of the InHealth Group, the diagnostic and imaging provider, reported a 23% leap in annual revenue to £218mn for the year end 30 September 2021, despite ongoing disruption from the Covid-19 pandemic. This was despite lower levels of activity across a number of its service lines being lower than pre-pandemic levels.
The adoption of business practices by SNHS services
So, the reason I have related the backstory about lab tech training is that it is much the same one that applies to primary care, specifically GP services. The financialisation, marketisation and, indeed, the stealth privatisation of health services now permeating our NHS, including the SNHS, has led to shortages in trained staff, fewer mentoring and on-the-job training opportunities and/or schemes for fledgling GPs resulting in much reduced staffing levels and poor staff retention.
Aside from the obvious changes, the rise of the so called ‘super practices’ and the increasing use of digital tools in GP practices.
On a practical level, it is all very well looking to nurses to upskill to take on some of the roles of a GP to alleviate demand, stress and to enhance capacity, but the loss of basic skills amongst GPs and reduced face-to-face consultations is unlikely to stem the flow of the chronically sick, and frail elderly patients. The reverse should be happening. Advanced nurse practitioners are ideal candidates for taking on GP roles in the future, and should not be considered as lower paid alternatives to a GP.
Is the reduction in the numbers of GPs because those qualified doctors looking to enter the GP profession cannot practice the full range of skills they have been taught at med school? Is the increase in advanced nurse practitioners a ploy to reduce business costs and not what it should be…an opportunity for advancement if desired?
Can private companies co-exist with public services?
Of course they can, but this collaboration cannot continue to be to the detriment of the SNHS and the Scottish government’s commitment to a wellbeing economy. The extraction and, some would say, exploitation of trained and skilled labour resources, at no cost to private industry, must cease together with the outsourcing of health services to private health entities. The SNHS has been stripped and denied of its assets… of its biggest asset – its people.
Is it too late to return to the ‘good old days’ when patients were afforded a consult/appointment with their ‘own doctor’? The SNHS must reverse the damage done through the adoption of business management practices. Politicians must start to prepare for an iScotland that will excel in delivering an SNHS capable of providing the necessary healthcare resources for a wellbeing economy by laying the foundation stones of a Central Bank to financially support our SNHS.
Much could be achieved when Scotland has access to the benefits of its own currency. For now, we should be addressing the demands of our healthcare professionals by investing in their futures – training and mentoring future generations. After all, they will be the ones providing a central pillar of Scotland’s desired wellbeing economy.
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