It’s difficult to write about anything to do with the ongoing crises within the Scottish NHS because in Scotland people have been lulled into a false sense of security with constant reminders that we have it better that the NHS in England and Wales. Perhaps we have, but a distinction needs to be made between achieving targets and actually delivering a healthcare service that meets the needs of people themselves – the service users. People point to targets being met or unmet; comparing and contrasting the healthcare services within the UK. This is unhelpful because it is often used for political point scoring and not as a means of determining which policies and practices need to be implemented to ensure more positive health outcomes.
Targets are a product of a healthcare service that has increasingly, over the last few decades, been operated as a business with layers upon layers of management whose sole purpose appears to be applying commercial business practices, e.g., cost analysis resulting in cost-cutting, often erroneously promoted as improving efficiencies within the service and saving on budgets. The perception that privatisation leads to greater efficiencies and better health outcomes, often under the guise of improved patient choice, is one which is constantly promoted to the general public by politicians. The reality is that in a health setting, successful outcomes are not forthcoming if they are led by business practices and directed by politicians, as referenced within Chapter 14 “Sorted” by Common Weal.
Addressing the social determinants of health
Numerous initiatives which have been clinically-led, such as the Scottish Deep End GP project – operating in deprived areas – have been very successful. Budget cuts have impacted on these types of projects which tend to be funded for a fixed term and resources are not provided for the long term. The role of politicians is to provide policy which addresses the social determinants of health outcomes – housing, education, inequality, and poverty. But central to their role, if a sustainable health service and wellbeing economy is to be achieved, is that politicians’ primary focus should be in providing the resources which are needed for the NHS Scotland.
The role of administrators in the health service should be to take direction from clinicians who know what resources are needed to support continuity of care and improve health outcomes. Too often, administrators and managers take their lead from politicians, setting targets and implementing budgets which are politically driven, and this is where the system needs reform. Austerity policies and a lack of political will to tackle the social determinants of ill health has resulted in lower life expectancy, higher rates of addiction, and suicide.
Despite all of the scientific progress and innovation, our health services seem to be regressing. This is not good news for future generations. We cannot continue to be passive recipients of healthcare based on a decaying under-resourced health service if the legacy we pass to our children and grandchildren is of a lower standard.
Where should resources be directed in the first instance?
Fact – 90% of healthcare takes place in the community, directed and undertaken by GP practices. It makes sense that primary care services within communities is where investment and additional funding should be concentrated.
All too often governments involve consultants at a huge cost to the public purse to come up with solutions to fix broken systems or those which need reform or, indeed, design new models. In the same way as the myth that privatisation of the health service creates cost savings, efficiencies and greater patient choice, a myth exists whereby consultancies always add value.
The reality is that consultancies are better suited to private business development where they can add value to the economy than they are to designing a public service system they claim to understand but don’t. Their costly schemes which often run overbudget in turn prevent the development of in-house capabilities, e.g. contracting out lab analysis to private companies instead of providing job security, staff retention, career development and training for those in the local community.
The ideological position has to be clear from Scottish government that they are committed to the NHS. Otherwise Scotland will become infected by the contagion from south of the border; the local GP that is known to patients and whom provides continuity of care – all of that is potentially under threat. The reality is that in some areas of Scotland, GP practices are not renewing their contracts with Health Boards and part-time locums are providing GP services instead.
Governments selective data mining
The accountability in the healthcare system is becoming so fragmented as well. There are some concerning issues in Scotland now around healthcare provision which have not been acknowledged at government level as they should be. It’s almost as if the Government are relying on the hard data which they think support their agendas. As a result, data that would best inform policy is not being collected.
It is entirely up to the people of Scotland and dedicated healthcare professionals as to how the Scottish Health Service (SHS) delivers in an iScotland and remains free at the point of need. Their votes for an iScotland will be the measure of their support for the SHS. Without those, we are at the mercy of a UK government which will dictate the where, when and if we have a SHS that we can access without having to return to the days when only the workers (mostly male), paid for treatment and the poor were left to fend for themselves, or rely on charity.
It is the role of a Scottish government to provide the resources to support our people in their efforts to retain the best healthcare provision, but it is not for the current Scottish government to determine how healthcare professionals deliver healthcare. If they wish to stay in power and deliver the resources necessary for a sustainable health service, they need to start preparing for the establishment of a Central Bank which will issue a Scottish currency needed to deliver the government spending required. A country which issues its own currency is truly independent and has the powers to invest in a well-being economy, of which the SHS would be the central pillar.
My thanks to Dr. Anne Mullin, a primary care GP in Glasgow for 20 years, who graciously consented to be interviewed by myself and Patricia Paton for providing valuable background info for this and future articles.
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