As doctors, we see on a daily basis that our health service is under massive strain. In many ways these figures give an indication of that, but they also provide some insight into the views of the public on the current state of the NHS.
That virtually a third of people think healthcare has declined or seriously declined, reflects the challenges we face as demand for care continues to substantially exceed the resources available to deliver that care. However, it should also be acknowledged that significant numbers also believe there have been improvements over the last decade. I have no doubt that demonstrates some of the tremendous advances made in the care we are able to provide – through advanced and innovative treatments for example. In my view, it also points to the dedication of staff across the NHS – not least doctors – who go above and beyond what is required of them to deliver the best care they possibly can. It is this commitment that can often cover up the more systematic failings caused by years of under-resourcing and understaffing.
It is also pertinent to see that this survey suggests that people do not believe the government is doing enough to meet the targets they have set. This should come as little surprise given that in general waiting times are lengthening, as services struggle to cope with increasing pressure. There are two elements to this that I would highlight. First is the fundamental link to staffing our NHS effectively. You simply cannot expect to meet the targets as they currently stand without sufficient staff. We know NHS Scotland is suffering from severe shortages of doctors across a range of specialisms, some of which are more acute in different parts of the country. If we really want to see a better performing NHS against these targets then greater efforts must be made to make becoming a doctor a more attractive career prospect than it is. Equally, there must be focused, targeted action to retain the doctors we already have. That means measures to improve work/life balance, proper and protected opportunities for training and career progression and a fair reward package that reverses years of real term pay declines.
Secondly, and perhaps an equally relevant question, is whether these are even the right targets in the first place. For far too long we have judged the success of our NHS on a set of crude measures that tell us little about the quality of care, or the outcomes for patients. These targets often ignore the judgment of doctors and pile even more pressure on a system that is bursting at the seams. That is why we must reassess how we use targets and data in our NHS. We’ll always need to measure performance, but we need to do it in a more mature way, which trusts the judgment of medical professionals.
Based on current targets, there is a serious question about whether the government could ever do enough to meet them in a sustainable and effective way, given demand which is likely to go on increasing. So unless something changes, it seems unlikely this perception from the public will change either.
Dr Lewis Morrison is chair of BMA Scotland