Exclusive:'Critical' reform needed of Scotland's 'unsustainable' health and social care system
Medical professionals and executives call for long-term change
Scotland’s health care and social care system is “unsustainable,” with the need for reform “urgent” and “critical” in the face of widening inequalities and a deterioration in the health of the nation, according to a group of senior health figures.
In an open letter calling on politicians to “reimagine” healthcare across Scotland, leading medical professionals and executives warned that while there are short-term needs that have to be addressed, there must also be a “longer-term vision” so as to deliver sustainable health care and social care systems for the future.
READ MORE: Open letter in full
The rallying call stresses that the scale of the change required goes beyond reform of the NHS, and includes the need to address the vital role played by third sector and local government. It has asked elected representatives to agree on a framework to engage in “private, respectful discussions” which allow long-term planning beyond normal electoral cycles.
The letter, published by Enlighten, the think tank formerly known as Reform Scotland, states that in order to bring about the change required over a single Holyrood term, there must be cross-party support, with politicians working with all stakeholders.
It states: “The current system of delivering health care and social care in Scotland is unsustainable, often stretched beyond capacity, overly complicated, difficult to navigate, often inefficient and is perceived as not always meeting the needs of people living in Scotland. The health of the nation is deteriorating and health inequalities are widening. Reform is urgent and critical.
“We understand that simply spending more money will not solve all of the problems we face. But a vision at the centre - of a whole ecosystem of health, a service of health care and social care for all and a culture that promotes equality and fairness and honours all who work in health and care and for a healthier nation - can make Scotland unique.
‘No quick or simple solutions’
It adds: “In reality, the challenges to health and the crises in our NHS are caused by a combination of complex and inter-related factors which have arisen over many years, for which there are no quick or simple solutions. Transformation is beyond the capacity of any one political party, government or group of stakeholders, who should not be expected to carry that burden alone.
“While there are urgent short-term needs requiring immediate attention and action, longer term change is essential and will make the biggest difference.”
Signatories to the letter include Dr David Caesar, an emergency physician and associate medical director, who said the reforms must go above and beyond party manifestos.
He said: “While there are urgent short-term needs requiring immediate attention and action, longer term change is essential and will make the biggest difference. We feel that the necessary consideration of what this will entail cannot be dependent on the needs of short-term party politics or conditioned by the next parliamentary election. We need a longer-term vision, shared by us all as a common responsibility.”
His fellow signatory, Jane-Claire Judson, chief executive of Chest Heart & Stroke Scotland, said: “We believe that there is potential for cross-party and cross-sectoral acceptance of common ground on certain issues, including what is and is not working well, which could then be discussed with our fellow citizens, openly and candidly, in the quest for effective, fair and sustainable long-term solutions. There are no easy answers, hard choices will need to be faced, and delivering the necessary reforms will take more than one electoral cycle. “
‘Bolder reform’ needed
Scottish Labour’s health spokeswoman, Jackie Baillie, said “Under the SNP the very founding principles of our NHS are under threat and patients and staff are paying the price. We need an end to SNP incompetence and waste - but we also need bolder reform to make our NHS fit for the future.
“A Scottish Labour government will cut the number of health boards and direct funding to frontline services and staff instead of bureaucracy. We will invest in primary care and social care to deliver early interventions and ease the pressure on hospitals.”
Dr Sandesh Gulhane, the Scottish Conservative shadow health secretary, described the letter as a “damning intervention.”
“Ministers cannot bury their heads in the sand any longer,” he said. “Continuing with their current approach is completely unsustainable and it is patients and staff who are paying the price.
“They are right to point out that throwing more money at the problem won’t fix it. We need to see real change within Scotland’s NHS, including an end to delayed discharge, which the SNP promised to eradicate a decade ago.”
He added: “While the SNP and other left-wing parties keep peddling the same tired, failed ideas, the Scottish Conservatives, under Russell Findlay’s leadership, are offering real solutions.
Tories vow to cut ‘bloated’ management
“That’s why we are proposing common-sense measures like cutting bloated management, and instead ensuring greater resources get to the front line, and especially GP services, where they are needed the most.”
Health secretary Neil Gray said: “We recognise the challenges facing Scotland’s health and social care system and agree reform is essential to ensure its long-term sustainability.
“That’s why we have already taken significant steps through our recently published operational improvement plan, which sets out clear actions to improve access to treatment, shift the balance of care, harness digital innovation, and strengthen prevention.
“We will also shortly publish our health and social care service renewal framework, which will set out a longer-term vision for modernising how care is delivered - ensuring services are more integrated, person-centred, and resilient for the future. We will work with health and care professionals, patients, and partners to deliver the change that is needed.”
Along with Dr Caesar and Ms Judson, the other signatories to the letter are: Dr Sarah Doyle, chief executive and nurse director, Queen’s Nursing Institute Scotland; Professor Andrew Elder, president of the Royal College of Physicians, Edinburgh; Professor Liz Grant, assistant principal (global health) and director of the global health academy, University of Edinburgh; Elizabeth Kelly, chair, Improving Wellbeing and Working Cultures Strategic Board; Dr Tamasin Knight, a consultant in public health medicine; Dr Donald Macaskill, chief executive of Scottish Care; Dr Alastair MacGilchrist, chair of Scottish Health Action on Alcohol Problems; Tejesh Mistry, chief executive of Voluntary Health Scotland; Rami Okasha, chief executive of Children’s Hospices Across Scotland; Professor Stephen Turner, former chair of the Academy of Medical Royal Colleges and Faculties in Scotland; and Charlotte Waite, national director of British Dental Association Scotland.
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