In my first message, as incoming chair of Scottish consultants committee, in the autumn of 2019, I quoted that famous phrase “winter is coming”. When I reflect back over what has occurred the last few years, it would be much more apt to say that winter is here all year round. The kind of pressure that we were used to experiencing over that one season are now part and parcel of our daily work, and as far I can see, this will continue to be the case for the foreseeable.
Obviously, a few things have happened over my time as chair to expedite the current crisis that we are experiencing in the NHS, namely the COVID-19 global pandemic, but I am clear that COVID is not the sole cause of the current issues. Back in 2019 I warned of the problems that the punitive pension taxation scheme would have on retaining senior doctors – jump forward three years and we can add into that mix a growing back log of elective care, a demand on services that outstrips capacity and burnout amongst doctors like we have never seen before. When we consider all of this, we can hardly be surprised that many consultants are now seriously considering early retirement or relocating to other shores. There has been very little sign of valuing the staff that we have, and hand on heart, if I am honest, looking at the spiralling pressure that the NHS is facing right now, if I needed treatment myself, I would be very nervous.
When we look across society now, it appears that we find ourselves in a new phase of the pandemic, one that appears calmer and for many like normal service has resumed. Those of us working in the NHS know that this is not the case and is certainly not what we are experiencing in our hospitals. What we are now seeing is the result of entrenched failure to invest in the NHS over many years, and while any and all new investment into healthcare is welcomed, what we have in front of us is a five year plan – not one for the here and now. We need something to be done for the staff today; to retain them, to support them and to prevent a brain drain from early retirement or better opportunities elsewhere. The problems that the NHS is facing are not specific to one particular speciality – it is a whole system failure; with no space in social care which leads to hospitals full of people who are waiting in a hospital bed, meaning acutely unwell people end up backed up in A&E. This results in ambulances unable to unload, which in turn leads to a lack of ambulances able to respond.
Added to this, the pressure on hospital capacity is leading to cancellation of elective activity, simply because there aren’t the beds to care for the patients. As elective waiting list continue to spiral, it is clear to me that we are creeping towards a two-tier system where those who can afford to pay for private healthcare will be able to access faster treatment, whilst the majority of the population are left waiting years to be treated. That is not the way I believe it should be, but unfortunately, if things are allowed to continue as they are, then a twin-track system is inevitable.
While we must plan for what a future Scotland needs from its health service, we also urgently need a current focus on retention. We have an ageing workforce and the only way we will get through the next five to ten years will be by retaining every possible member of staff we can. The Scottish Government’s aim of creating a network of dedicate elective hubs, capable of delivering an extra 40,000 planned procedures a year is not without merit, but we have to be honest about where the extra capacity in staff is coming from. In many ways, working in the new dedicated elective centres will offer a better working experience for staff, so we need to ensure the working conditions in the acute sector keep pace. Unless there is a substantial increase in frontline staff, then pushing ahead with these plans will only further destabilise acute care. It is time to be truthful, to have the difficult conversations and be honest with the public about what we are able to deliver with the resources we have.
So let me end how I began those three years ago…pensions. It is beyond frustrating that the pensions fiasco has still not permanently been addressed by either the UK or the Scottish Government and it is absolutely not for lack of trying on our part. We know that the ludicrous tax system is driving doctors to drop sessions, to refuse additional work or retire early and I know that I am not alone in feeling this frustration in the lack of progress that either administration has made in trying to solve this problem. As I look to the Scottish consultant committee, I know my successor will pick up this baton and continue to make this a priority because the entire committee feels as strongly on this as I do.
I would like to take this opportunity to thank you for all the support over the last few years – when I took on this role I expected it to not be without its challenges, however I definitely underestimate the kind of challenges I would end up facing. It has been a great honour to do this job and to work for the profession in such a critical time in its history. I know I wouldn’t have been able to do so without the support of my family and colleagues on the committee, and to them I am very grateful. And on that note – lets try and find a positive. We have a hugely talented and dedicated workforce in our NHS. I’ve seen that more than ever over recent times. If we get the support we need – the trust in our medical leadership and a system that is properly funded – we can work together to deliver a sustainable NHS fit for the future and the demands of caring for the people of Scotland.
I know I will be leaving you in capable hands, whoever it might be, and I look forward to continue to work hard for consultant doctors, from the back benches.
Dr Graeme Eunson, chair, Scottish Consultants Committee