The NHS in Scotland 2016

This week has seen the publication of the Audit Scotland report into the NHS in Scotland.

I don’t know about you, but when I see the word “audit” my eyes start to glaze over and all the accountants I have ever known (no offence, guys) start to swing into focus, along with spreadsheets, balance sheets, graphs, dense pages of numbers and all the other paraphernalia of their profession. In the case of this report that is a shame because what it says is presented in an accessible way in under 50 pages. There are clear summaries and headings and its conclusions are unsparingly and simply presented. Above all, it is independent.

If you want to read the full report, simply click on the link or the picture above. However, the key messages are:

1. Over the last decade there have been improvements in the way health services have been delivered
2. NHS funding is not keeping pace with demand
3. Health Boards are struggling to meet the targets set by the Scottish Government
4. Work force planning is a huge problem (ageing staff, ageing populace) and there is far too much use of agency staff
5. Huge changes are underway including the integration of health and social care – these are essential, but are not happening fast enough

The key recommendations are:

1.The Scottish Government should

a)have a clear written plan for public health education, workforce planning, managing change and communication with the public

b) have clear measures of success for progress in implementing its plans

2. NHS Boards should be given more financial flexibility to plan for the long term.

3. There should be partnership working by the Scottish Government, Health Boards and the new local Health and Social Care Partnerships.

Because the NHS is inextricably bound up with politics, the Scottish Parliament this week was the scene of fierce debate about this report and its recommendations. To you and me, the recommendations may seem clear and straightforward, sensible even, but instead of our politicians simply accepting the expert recommendations and working together to plan for the future – our future – there was instead a great deal of schoolboy/schoolgirl shouting across the chamber during the weekly session of questions to the First Minister/Headmistress. This can be summarised as follows:

First Minister/Headmistress (SNP): Things in the NHS are pretty good, but simultaneously we recognise they are not pretty good and will be improved. The Tories are nasty. Labour are hopeless. The Lib Dems are insignificant.

Opposition (Tory/Labour/Lib Dem): This situation is an outrage. It is all the fault of the Headmistress and her party’s incompetence over 10 years and shows they are prioritising the wrong things, in particular separation from the UK.

The Greens are also represented in the Scottish Parliament, but chose to ask why the Headmistress was in favour of building a new runway at Heathrow. (Apparently polluting larger stretches of west London is “good for the Scottish economy” according to the HM).

Now, if you are Scottish, you may have your own view of all of the above and you will realise that, taking my lead from our politicians, I have greatly over simplified what are complex and challenging issues.

To return to the real world and the audit. One of its excellent features is that the auditor general has chosen to illustrate the report with examples of real life challenges that the NHS in Scotland is facing as a result of the system-wide problems she identified.

Some progress is being made towards new models of care, but it is not happening fast enough to meet the growing need. Effective leadership and a clear plan are needed to manage the change. (p34)

As a stroke survivor, this one stood out for me:

At the Langlands Unit, part of the new Queen Elizabeth University Hospital site in NHS Greater Glasgow and Clyde, an acute stroke and rehabilitation ward was short-staffed each day of the inspection. The absence of a senior charge nurse meant there was a lack of leadership and risks for patient safety. There were particular issues in relation to poor nutritional care of patients. Some patients on the ward said that there were not enough staff and that nurses were too busy to check up on them or answer their requests for help with toileting or bathing. (p27)

I seem to remember experiencing exactly the same problems as a stroke patient back in 2004 – great staff, just not enough of them. And this in a week when new research indicates that there is a direct co-relation between the absence of experienced nursing staff and poorer outcomes for patients.

Have we moved on at all in 12 years as far as stroke care is concerned?

There is no point in asking the Headmistress and her adolescent political tribes at Holyrood en masse, but, if you live in Scotland, there is every point in posing your questions as an individual to your local MSP. The more people who do so, the more likely it is they will stop their posturing and try to fix the system.

There is one word that is used eight times in the auditor’s report – it is “partnership”. We need more of that, not just between parts of the health and social care system, but between those rowdy pupils at Holyrood and us the public who pay their wages and ultimately fund the system.

As I have said in previous posts: the UK is one of the richest countries in the world; we can afford this.