How did NHS Scotland get to the point where it was in danger

NH Scotland
  • The NHS's crisis is reflected in the growing demand for private healthcare.
  • It's depressing to read the public service report from Audit Scotland.
  • Despite adding significant funds to its budget, it is struggling to turn things around. The study examines urgent non-financial changes that are needed.

In addition to a gym and rooftop terrace included in the rent of your apartment, you also have access to a virtual doctor within a half-hour or less, who will then quickly deliver your prescription.

This is not a gated, well-to-do senior community in the US sunbelt; rather, I just received a marketing tidbit claiming that it will soon be coming to a housing development in Edinburgh and other British cities.

The goal of Moda Living is to build the "happiest and healthiest" possible residential neighborhoods.

While a branch of the Lloyds Pharmacy network offers your general practitioner services, your rental agreement also entitles you to 40 percent off private counseling, therapy, and wellbeing sessions to enhance your mental health.

However, the way in which private health care is provided is also adapting to what is happening in the NHS and appears to be a sign of things to come.

More people are turning to private health care and two-tier systems due to the NHS's shortcomings and lengthy waiting lists.

Self-pay options and health insurance have both grown in popularity. According to data from a health data consultancy last year, self-payment for medical services without insurance increased by 84 percent in Scotland and by 39 percent in the UK.

Audit Scotland recently released one of the best advertisements for private health. It's a somber read.

It fails to take into account the large number of people who seek assistance from the NHS during times of need and are delighted by the excellent work done by its employees.

As an alternative, it examines healthcare data. According to the report, there are "extreme" and "severe" pressures, slow progress in Covid recovery, declining performance on cancer targets, and "financial struggles.".

The government spending watchdog has brought up what it sees as the NHS's unachievable organizational and financial limits in the past, through Covid and organizations that came before it.

It highlights health boards who are expected to provide services far beyond what their budget can support. .

For instance, NHS Argyll and Clyde claims that $13 million is required to meet waiting time reduction goals. It will receive £7,018,000. NHS Highland claims it needs £12.5 million, but only £8 point3 million has been allotted.

NHS Scotland sign

According to Audit Scotland, only three of the 14 territorial health boards (aside from national boards for specialist services like training) are on track to break even this fiscal year, assuming they meet their savings goals. To put it another way, saving £621 million would be necessary for all the boards to break even.

The service frequently following a political timetable may be one of the reasons why the money is not being used as expected. It is noted that within 100 days of the 2021 election, the NHS Covid recovery plan was promised.

According to Audit Scotland, fulfilling that promise necessitated not consulting the health boards. Nevertheless, it is up to them to perform.

From above, goals are set. When health boards don't show up, they are summoned and reprimanded. Why anyone would want to serve on them has long baffled me.

More than £19 billion will be allocated to Scotland's social care system and NHS in 2019, which is more than they were expected to get in 2026–2027.

It entails cutting back on other expenses. However, the issues with the service are still not resolved.

Money cannot be the only component of the solution, according to Audit Scotland.

It urges ministers to engage with the public more effectively and has a strong message for the government regarding what the public is told the NHS can provide.

Public health improvements play a role in some of that. The obvious solution to the issue of supplying health services is to reduce demand for them.

A healthier workforce at work can also help with the supply issue.

Each year, Audit Scotland serves as a reminder to the Scottish government that hiring and keeping employees also means ensuring their better physical and mental health, which will enable them to meet those expectations.

Filling workforce vacancies in wards and clinics is among the best ways to assist those who work in the service.

According to a Royal College of Nursing survey, 86% of respondents did not think that patients were cared for safely and effectively during their most recent shift. About 63 percent of respondents said they were exhausted and dissatisfied with staffing levels, and 59 percent said the problem had sapped their morale.

In a survey of trainees conducted by the General Medical Council, 62% were found to be at moderate to high risk of burnout. Twenty percent or more of health professionals take sick days on a daily average.


The Scottish government is aware that asking for assistance is not a culture in NHS workplaces. Additionally, the watchdog notes that while more mental health services are being implemented, more should be done for physical wellbeing, including providing more space for staff to take breaks.

One impact is the exorbitant cost of hiring agency nurses to try to fill some of those gaps. Since 2017, the cost for bank and agency nursing staff has increased by 93%, to £321 million.

The cost of hiring staff from abroad, which averages £12,000 for nurses and £10,000 for allied professionals like physiotherapists, is another waste of money.

Where are they supposed to live affordably, asks NHS Highland, even where you can attract them?

Others worry that doctors and nurses will leave underdeveloped nations, where they are even more needed.

The glaring message has been that workforce planning is woefully inadequate for a number of years.

Although there are gaps throughout the entire service, the GP issue is among the most glaring.

A lot of people have left the field or changed to part-time work. The number of "whole time equivalent" general practitioners is down 26% from 2017 when part-timers are taken into account.

The creative solution is to hire more people to support GPs, and Audit Scotland reports that since 2017, progress has been made in this area. However, it is still seeking proof that the additional 3220 employees in these positions are actually contributing the way they should.

It claims it's unlikely that the goal of 800 new GP hires will be accomplished. On BBC Radio Scotland, Health Secretary Humza Yousaf asserted that he has 250 so far. That is strange because Audit Scotland can only locate 113.

Humza Yousaf
Increased GP enrollment in NHS Scotland is a goal of Health Secretary Humza Yousaf.

More people being trained for positions in the health service will help in part. More funded spots are being made available in nursing and medical schools, but Audit Scotland expresses worries about enrollment and attrition as well as a shortage of seasoned GPs to supervise trainees.

In a report released two years ago, Audit Scotland suggested that the Scottish government and NHS Scotland increase the quantity and quality of workforce planning data.

"We have seen little evidence of progress with this," the report for this year concludes.

Unsurprisingly, the watchdog report was used as a weapon by the opposition to criticize the Scottish government and Mr. Yousaf in particular. Whataboutery—as in, "what about the situation in other parts of the UK?"—is frequently used as the ministerial response.

Although the comparison sets a low bar, that is a fair question. After years of emphasizing how effective it is to maintain capacity near demand, the shock of Covid has left the NHS struggling to recover.

On the same day that Audit Scotland issued a critical report on the NHS in Scotland, the Institute for Government was considering a similar set of problems in England.

The defenestration of two prime ministers over the course of the summer and fall has caused political instability and administrative paralysis, according to its performance tracker, which serves as a scene-setter for the Westminster budget on March 15.

"Winter pressures have combined with long-standing issues in adult social care, hospitals, and primary care to result in the worst NHS crisis in a generation," the independent think tank, whose staff includes some who have worked inside Whitehall, continued. ".

The institute continues, "The UK government's strategy on dealing with public sector strikes, when they occur, has not helped and probably further enraged the frontline workers needed to restore public services.".

According to that, that has also served to scuttle the agreement on public sector pay that was achieved through pay review bodies, and that also has an impact on Scotland.

The extreme measures and compromises that were required of doctors during the pandemic are still in place as a result of these pressures. .

Edinburgh general practitioner and author Gavin Francis recently wrote in the magazine 1843 with a reflection on advice he received from the General Medical Council last November: "A sensible, supportive and necessary intervention in 2020, intended to reassure a workforce facing a terrifying pandemic, had, by 2022, become something far more sinister - an acceptance of a new status quo, and a chilling normalization of crisis.

. "

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