The truth about Scotland's NHS: 'Crisis goes back to coalition'

AFTER battling through the Covid pandemic, the NHS in Scotland is still facing challenges like never before. From record waiting times to looming strikes, there’s an endless stream of grim headlines.

In a new series, we are going to examine in more detail what has happened to the health service and how the issues can be solved.

Today we look at how much of the difficulties currently being experienced can be attributed to the pandemic – and whether the rest of the UK is faring any better than Scotland.

The NHS across the UK will take years to recover from the impact of the pandemic – with this winter expected to be the “hardest of all”, experts have warned.

With increasing waiting times in A&E, a backlog of patients waiting for routine care, and a series of strikes on the cards, there’s no doubt that the health service in Scotland is facing a severe challenge.

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But it’s not the only part of the UK where the NHS is under strain, with the pressure building for some time due to issues such as an ageing population, increasing demand for services and high staff vacancy levels.

So just how much is the Covid pandemic – which saw the greatest disruption to the NHS in its more than 70-year history – to blame for today’s problems?

Dr Syed Ahmar Shah (above), chancellor’s fellow at Edinburgh University’s Usher Institute, has led research looking at the impact of the pandemic on hospital care in Scotland, England and Wales.

He said there has been a declining performance which has been drastically speeded up by Covid, with overall trends comparable across the UK.

One illustration of this is figures from England which show there were 4.5 million people waiting at the beginning of 2020, but during the pandemic that number increased to around 6.5m.

That two million rise was equivalent to the amount by which waiting lists had previously grown between around 2013 to 2020, Ahmar Shah said.

“During the pandemic, what happened in seven years you see taking place over two years,” he said.

“The decline was already happening for much longer before the pandemic, but that decline became about four times worse.”

The latest figures for Scotland show performance on waiting times at A&E units hit a new low, with just 63.5% of patients dealt with within the target time of four hours.

NHS England statistics reflected a similarly poor picture – with 69% seen within that time in A&E and minor injury units.

The target of having 95% of patients seen within four hours has not been met since July 2020 in Scotland – while for England, the last time it was achieved was in July 2015.

Mark Dayan, policy analyst at the Nuffield Trust, said the NHS across the UK was struggling with missing waiting times targets across the board, as well as serious problems with staff leaving.

He said: “Where they can be easily compared, in A&E, Scotland’s waiting times problems appear broadly similar to those in England, with Wales and Northern Ireland struggling more.”

He added: “The NHS is grappling with a significant backlog of care and across the four nations will struggle to bring this down quickly with current staffing levels and all-year-round high levels of emergency and urgent demand.

“But the care backlog cannot be solely attributed to Covid-19, instead, it is a consequence of the collision between a pandemic and a health system already stretched beyond its limits.”

The Scottish Tories have in recent weeks tried to lay blame at the door of Scotland’s Health Secretary Humza Yousaf (below), accusing him of “chronic mismanagement” of the NHS since he took up his post in May 2021.

Speaking on a visit to Wishaw General last week, Yousaf hit back saying: “To make this about an individual or even about a political party I think it missing the point – the point is we have had the biggest shock the NHS has ever faced in its 74-year existence.

“What we are focused on and I am focused on is what can we do to help us get through this winter – simply changing people around or even changing frankly political parties is not going to be an immediate solution for the NHS.”

THERE’S not been the same pressure on England’s Health Secretary – perhaps because, thanks to the chaos of the Tory government at Westminster there have been four in the post over the same amount of time. Current incumbent Steve Barclay first became Health Secretary after Sajid Javid quit in July 2022 as part of the wave of resignations which eventually triggered Boris Johnson’s downfall.

He was replaced by Therese Coffey after Liz Truss became Prime Minister, only to be reappointed last month when Rishi Sunak took the keys to Number 10.

Mark Exworthy, professor of health policy and management at Birmingham University, said there had been a worsening crisis in the NHS, stretching back to the time of the Tory and LibDem coalition government at Westminster.

“The story goes back to the effects of austerity – and then we get Brexit and then we get Covid – it is the effects of all those coming into line, and probably each is deepening and accelerating the problems of each other,” he said.

“If you take for example, waiting times, the graph has been sloping upwards for waiting times since the 2010s and then did seem to take a bit of a sharper turn around 2016/17 and it has been higher since with Covid.”

He added: “We’ve seen the wait times in summer have been getting as bad as in winter. There is normally a natural cycle of up and down, but if you are on a rising graph then the downs not too many years later become as high as the peaks previously were in the winter.”

Exworthy said one key issue was the workforce, with a UK-wide vacancy level of around 10% for nurses, doctors and other groups even before the Covid pandemic and an unaddressed crisis in social care funding and staff vacancies also compounding the challenges faced by the NHS.

“The ground the NHS was working on was tricky, difficult to start with – we have got an ageing population as well,” he said.

“Then Covid comes along and that becomes a national moment of galvanising effort and clapping for the NHS is a symbol of that.

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“But the effects go really quite deep in terms of accelerating a lot of the issues around vacancies, around burnout and work-life balance, and job satisfaction.”

He added: “I suspect this winter will be the hardest of them all, in that we are going in with a less healthy population, we have got vacancies and workforce issues and some vestiges of Covid, that is still not to be forgotten and then a strike – not just for nurses, but many other groups and occupations in the health service as well.

“The scale of the challenge is huge.”

However, Exworthy added: “Not everything is terrible in the NHS – a lot of patients do get the right care at the right time, high quality care with caring staff.

“We need to bear that in mind, this isn’t a completely dismal picture and there is a very strong performance in many areas.”

This is part one on our new series on the truth about Scotland's NHS.