THE leader of Scotland’s doctors has called for an honest debate about the future of the NHS in Scotland and how it can deliver high quality care with financial constraints.
Speaking after the referendum result was declared, Dr Peter Bennie, chairman of the British Medical Association (BMA) in Scotland, said “hard-pressed” NHS services were now running on the “good will” of doctors and other staff, many working longer hours to get the job done.
He called for more action on staff recruitment and workload to avoid the risk of the service “breaking down”.
Dr Bennie, who was only appointed BMA Scotland chair last month, said while the outcome of the referendum had been determined, the as yet undefined offers of further devolution of powers to Scotland may have a significant impact on the health service.
While the NHS was repeatedly brought up as a talking point by both sides of the referendum debate, the BMA remained neutral in its stance on the issue of independence.
Speaking in his first interview since the referendum result was announced, Dr Bennie said they would maintain this stance as a membership organisation representing people with different views and because of the negotiations they had to undertake with politicians.
“You can’t take a position in that situation and we won’t be taking a position on whether it should have been a yes or a no just as we didn’t take a position in advance,” Dr Bennie said.
“But what is crucial are these shifting sands we are standing on just now and what happens next and what extra powers are going to the Scottish Government and what the changes will be on a UK basis.
“All of that is bound to have an effect on the things that we do.”
Dr Bennie said the BMA was pleased that both sides in the referendum had pledged to stay true to the founding principles of the NHS and maintaining that in Scotland.
But he said the NHS was facing major challenges going ahead due to factors such as reducing budgets, an ageing population and more people living with complex conditions.
He said there needed to be “an honest, public debate about the future of our NHS”.
In the last week leaked reports have emerged suggesting a £450m funding gap in the NHS in the next two years, sparking concerns from some about changes that might be needed in some services.
Dr Bennie said: “I expect that we will get much more clarity in the near future about what the funding is likely to be for the next couple of years. Yes or no that was always going to be tight.
“The discussions we will be having with the Scottish Government are, within those tight financial constraints, how do you run a health service and ensure that you are addressing the problem with recruiting doctors and make sure you are providing a good service across all hospitals?”
Dr Bennie said NHS services in hospitals and communities were currently running on the good will of doctors and other staff.
“There are substantial problems with recruitment and we are starting to see that come to prominence,” he said.
“We know doctors across the country are working several hours above their contracts. That is what we mean by good will.”
Dr Bennie said at the same time there had been cuts to doctors’ pensions which he described as a “selective tax on public sector workers” to help plug funding gaps elsewhere.
“Everyone working in the NHS is committed to it and working those extra hours and extra miles, but eventually if you keep relying on that rather than having sufficient numbers of staff to do the job well you are running the risk of the service breaking down.”
Dr Bennie also expressed concerns about the number of doctors’ posts lying vacant across the country, with statistics only available on advertised jobs which had not been filled rather than those which had not been advertised by health boards.
“It is clear from speaking to doctors that there are posts that are not recruited to which are empty,” he said.
“That is a classic way of saving money and it has been in the health service for a long, long time.
“Some of that difficulty is to do with the training structure, but others are much more about opportunistic saving of money while a post is vacant and reliance on others in the hospital or practice to carry the slack.”
Dr Bennie said they would like to see a serious commitment from the Scottish Government and health boards to say what the vacancy rates are and what they are doing about them.
The issue came to a head recently when A&E doctors in Grampian expressed concerns about a lack of staff affecting services.
Dr Bennie, a psychiatrist based in Paisley, said progress had been made in improving funding for mental health services, but this had been at a time of rising overall budgets.
“We don’t appear to be in that situation just now and I do have a fear that mental health might be seen as a softer target for cuts than other parts of the service, and that would be wrong,” he said.