Will there still be an NHS in another 75 years?

Dr Iain Kennedy, chair of BMA Scotland, the trade union and professional body for doctors

THE 75th anniversary of the NHS was an important moment to celebrate what remains one of our country’s finest achievements. But we should use anniversaries like this also to look to the future and reflect on how we protect our NHS and put it on a sustainable footing for years to come.

There is no doubt – and anyone who works in the NHS will tell you this – that our health service is struggling badly. Demand is outstripping capacity and staff are being pushed beyond what we could or should expect of them. This is making things worse for patients, faced with long waits for care – or services that simply aren’t delivering as they should. Sadly it is the staff who are left apologising for this sad state of affairs.

That’s why we’ve called for a realistic national conversation on the future of Scotland’s health service. It must be honest and open about the challenges and build consensus across the public and political parties on what reforms are needed and how they are implemented.

There needs to be a short, medium and long term plan for Scotland’s NHS, which includes in the short term a realistic plan to cope with immediate day-to-day pressures and the coming winter of 2023/24, and an effective workforce plan to make sure that in the longer term, we have the doctors and the wider multi-disciplinary team members we need if we want NHS Scotland to survive over the coming years and decades.

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The National Conversation has to produce a plan that is delivered upon, and not another document left to gather dust. The Scottish Government and indeed First Minister Humza Yousaf have already committed to this conversation – when I meet the Cabinet Secretary, Michael Matheson, next month, I will be pushing him on what progress has been made, and when the work on this will begin. We can’t afford to wait much longer, if we want our NHS to not just survive, but rather flourish well beyond its 75th birthday.

Colin Poolman, Royal College of Nursing Scotland director

IT is tricky to look too far into the future given the level of pressure and number of challenges facing the NHS right now.

In its 75 years, the NHS in Scotland has been characterised by the commitment of its staff and innovative approaches to best meet the need of patients. That continuing spirit provides hope for the future.

But much needs to be done to secure the NHS in the short to medium term first if it is to be fit to meet the ever-changing needs of Scotland’s population in the future.

We must see the successful implementation of the Health and Care (Staffing) (Scotland) Act, legislation designed to deliver and protect safe staffing levels. This is due by April 2024 and it must be done effectively.

Realistic conversations with the public about expectations, access to services and what is achievable are desperately needed. This must recognise the important role of health promotion and prevention to support improvements in the overall health of the people of Scotland.

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Above all we need sustained investment in nursing. Investment to grow and develop Scotland’s nursing workforce in both our NHS and in social care – as one can’t function without the other – and to ensure the role of nursing is recognised, valued and appropriately rewarded.

The Scottish Government must bring forward sustainable domestic recruitment and retention planning that will turn the tide of persistent nursing shortages. It must look at how we retain experienced nursing staff, attract more people into the profession and ensure nursing is a career of choice once again.

Derek Thomson, Unite The Union Scottish secretary

IT is clear to all – whether you are a worker within it or as a citizen using the service – that the NHS, in many places, is close to or beyond breaking point.

We have seen this with paramedics, call-handlers in NHS24, those working in A and E units and in the community. The depressing situation pre-dates the onset of the Covid pandemic. It is due to years of chronic underfunding by both the Scottish and UK governments which the pandemic starkly exposed.

The underfunding has massive implications for the quality of service and on waiting times despite the very best efforts of staff who are often stressed and exhausted due to being understaffed.

There is a clear and urgent need for more investment in the NHS including the workforce, rather than hiving off areas for outsourcing and to the private healthcare sector. If we continue to go down this perilous path which is under way in Scotland, there will not be a genuine free and first-class NHS for all but a lottery-based service that will be defined by your ability to pay or where you live.

Matt McLaughlin, head of health, Unison Scotland

THE NHS in Scotland is in crisis. It needs reform and investment, both for the short and long term. Surveys consistently identify short-staffing as a major pressure on service delivery and staff wellbeing. And the Government’s own workforce statistics show unfilled vacancies are higher than ever and on the rise.

In the short term, we need to reduce agency spending and make more effective use of existing staff. Longer term, the NHS needs effective workforce planning. We need to attract more students, improve in-work training and facilitate working into later life.

Social care has massive problems in recruiting and retaining staff largely because of the low pay and poor working practices, particularly in the private sector. It is a significant factor in NHS delays in getting patients back into the community and freeing up NHS resources for others to get treatment. In the short term, we need to improve pay and conditions for this largely women workforce. In the long term, we need to build a national care service worthy of the name.

We obviously need motivated, well-resourced doctors but the pandemic taught us that for some, a phone-call consultation works just as efficiently as a trip to the surgery. And many people don’t need a doctor – they need a nurse or other allied profession. Across the NHS we have extremely effective non-doctor led health services, making a huge difference to the lives of their patients.

Lastly, the Scottish Government needs to get serious about public health. Scots have not shaken off our label as the sick man and woman of Europe. More Scots live longer, but generally we are doing so in poor health, which itself puts demands on the NHS.

Kenryck Lloyd-Jones, Chartered Society of Physiotherapy (CSP) public affairs manager for Scotland

AS we celebrate 75 years of the NHS, we cannot avoid the question of the sustainability of our national health service into the future. Without question, the greatest challenge comes from demographics. Like most western industrial nations, Scotland has an ageing population.

This, of course, is also something to celebrate. But the key to the future of the NHS is healthy ageing. Increasing numbers of people living longer but living out their old age with frailty, illness and long-term conditions puts considerable strain on health and social care services, requiring more staffing numbers and ever greater investment. And we all want to enjoy a good quality of life into old age

Last year, Scotland’s NHS faced the hardest winter on record. This winter is set to be worse, with climbing waiting times and staff shortages, all while recovery from the pandemic is not over. We have been warned for the last two decades that the current model is not sustainable – and while progress has been made, we have not done enough to redesign our essential approach to health.

There is only one way out of the predicament. That answer is healthier communities, and this doesn’t begin with education leaflets. It begins with improved access to high-quality community rehabilitation.

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Rehabilitation has a vital role in recovery. Rehab is essential for those living with long-term conditions, physical injuries and poor mental health. A future healthier society means preventing hospital admissions, facilitating early discharge out of hospital, supporting people to return to work, to live independently, reduced reliance on health and social care and investment in paths to healthy lifestyles in every community. Rehabilitation is the driving force for a healthier future, with less pressure on stretched services.

The CSP is one of more than 20 professional bodies and third-sector organisations in Scotland campaigning for a “Right to Rehabilitation”. Investing in rehabilitation, with the involvement of health and social care, and the third sector, would ease the pressure on hospitals and keep the whole system sustainable. It would ensure early intervention and create and support community assets to enable people to lead healthier lives.

We must find a way to expand the rehabilitation workforce in communities and incentivise the system around prevention rather than managing ill health. Over the coming years, Scotland must establish a meaningful right to rehabilitation that supports people from hospital to healthy living in their communities.

The media focus on accident and emergency services and hospital operations shifts attention away from the less visible everyday primary care and community rehabilitation. But if our rehabilitation services are left to struggle and fail, there will not be a National Health Service in another 75 years. It is that important.

Sara Redmond, chief officer of Development, Health and Social Care Alliance Scotland (the Alliance)

SEVENTY-FIVE years of the NHS is a noteworthy point in history. The NHS has demonstrated its ability to adapt to the many different health challenges over these years.

However, there is no doubt of the need for continued reform as we approach the next 75 years. The last decade has seen a widening of health inequalities, leading to too many people dying earlier than they should. We know the human impact of this from the Alliance’s Community Link Workers – too often they come into contact with people whose health and wellbeing has been impacted by a lack of appropriate housing, mental health support or an adequate standard of living.

It is essential that human rights are brought into law in Scotland so that there are stronger protections for people to have their rights and dignity respected. It is also vital that the role of Community Links Workers continues to be expanded, to help proactively address the issues people face.

Adam Stachura, head of policy and communications for Age Scotland

THE NHS is such an important and precious part of our lives and everyone wants to see it thrive over the next 75 years.

Its amazing principle of being free to use at the point of service is one which, unfortunately, isn’t always realised in practice across Scotland as many people aren’t able to access it when they need it, and face long waits for appointments, procedures and treatment.

Moving from crisis responses to more preventative healthcare, addressing health inequalities, and faster and more local access will drastically improve people’s quality of life.

There are big challenges ahead which will need much more focus and resource to fix in the short term as well as transforming it for the decades to come. Scotland’s rapidly ageing population will require more healthcare and support, and the NHS must adapt to meet that need. Never mind the next 75 years, but in the next two decades alone half of our population will be over 50 and the number of people over 65 will grow by a third.