Chair’s Festive message: Now is the time for a national conversation on the future of the NH…

This is my first opportunity to deliver a message at this time of year – both on behalf of, and directly to doctors in Scotland.

It’s something, like all aspects of my role as your chair which I approach with relish. But its also pretty daunting, as getting the right tone is hard.

I desperately want, as do most people at this time of year, to be optimistic and forward looking. To set out some hope for the future for the medical profession that I am so proud to be part of and the Scottish health service I am equally proud to work in.

But it’s not easy to find that indication of a brighter future. No-one working in the health service in Scotland would give me any credibility if my message was an upbeat description of the way our NHS will or can get better and how the working conditions of those caring for the people of Scotland will miraculously improve.

The problems are just too long standing, so deeply entrenched that there is no magic bullet. At BMA Scotland we have warned of this direction of travel for some years. Yes, it’s been made worse and more urgent by the pandemic, but let’s not kid ourselves that Covid is the cause of the crises we face.

All the statistics on the NHS tell us this desperate state of affairs is the case, and things are as bad as or worse than they have ever been. Winter is a now a meaningless term in our NHS. It used to be the busy time we struggled through – and emerged from grateful to be heading into calmer waters – but now ‘winter pressures’ are just what we experience every single day.

But we also need to look beyond the statistics to how this is impacting the care being delivered by doctors and what it means for patients. We asked for that first-hand experience from you, our members – and we have heard some hugely worrying testimony. If the raft of regular and incredibly concerning health service statistics isn’t enough to prompt clear action – then I believe these kind of personal experiences must surely be. Below are just a few excerpts of the responses we’ve had. They speak louder than anything I could say to list the many, various and hugely serious problems we face.

Of course this is having a major impact on the medical profession. I know we face crises across workload, workforce, working conditions, pay and pensions. All of these things are hitting efforts to retain doctors – which we are already desperately short of, across both primary and secondary care. Hospitals have too many vacancies and GP practices are falling over. We simply must stop this haemorrhaging of crucial staff, who we urgently need now more than ever before. You can talk as much as you want about recruitment of staff, of investment in the system or of plans for improvement, but every single one will fall flat on its face unless we have a laser like focus on keeping the staff we have. That is why retention of healthcare professionals – keeping them in the service – needs to be the number one priority in terms of the more short-term fixes to help us even just make it through with the NHS in Scotland somehow intact.

Looking beyond that, of course we need to finally get a proper long term workforce plan in place. But even more fundamentally we need, as a whole society, to grasp the nettle, face up to hard truths that have been put off for far too long, and have a proper grown up, de-politicised national conversation about the future of our NHS in Scotland.

Sticking our heads in the sand – or exchanging tired political soundbites – just won’t cut it anymore. We put forward this idea in our manifesto for the last Holyrood election, and support does seem to be growing. It’s clear we need to reflect on what we ask of our NHS and the levels of funding we, as a country are prepared to provide to meet those asks. More funds need gathered, and spent wisely. The current approach of pushing insufficient resources harder and harder, then blaming staff when standards fall has failed and is failing patients every single day. I know doctors across Scotland are suffering moral injury as a result.

Some may say: how can we do this when the NHS in Scotland is in crisis? But I would say, if not now, then when? Just how bad does it have to get? If we keep putting this national conversation off, we run the risk of simply lurching from this crisis to the next. Any marginal improvement may be used as justification for kicking the whole thing into the long grass yet again. A slight easing of pressures and political leaders may take the chance to go back to relying on staff who are on their knees – and are likely then to simply give up altogether and leave the NHS.

Instead, let’s harness the anger and frustration we all feel – staff and patients alike – to commit here and now to working together to build a better future. Let’s stop putting healthcare workers in the impossible and insidious position of having to constantly be apologising and being the bearer of bad news. That means politicians on all sides have to step up and start the process. It is in their hands, and specifically the hands of the Scottish Government. With all the political attention on our NHS in Scotland at the moment, I have no doubt they are listening. I also believe they want to do the right thing. We now need them to be brave and act – by bringing us together and finally actually properly talking about a plan for a future NHS we can all confidently get behind.

I started this message seeking optimism, and perhaps I have finally found it in the suggestion that a national conversation on the future of our health service is an idea for which the time has come. We need to consign blame, fear and perpetual crises to the past, but that won’t happen unless we look beyond electoral cycles and party politics. And a better NHS will be better not just for Scotland’s doctors, but for those who rely on it for care. We’ll be pushing for the Scottish Government to start leading this conversation as soon as possible and again, I am truly optimistic they will listen. So yes – let’s try and look to the future with that optimism and hope and I look forward to keeping you updated across 2023.

NOTE: If you are finding it tough, please do use our wellbeing services. We have a range of services and information to help support you. Our counselling service is open 24/7 to all doctors and medical students – by telephone and in person. It’s confidential and free of charge.

Dr Iain Kennedy – chair, BMA Scotland

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