Before coronavirus, the NHS was close to breaking in places. We need to look after its health too – Dr Lewis Morrison

The NHS cannot simply have more demands heaped upon it. Now we need a national conversation about what it can do, writes Dr Lewis Morrison.

Royal Parks staff applaud the NHS's 72 birthday with a specially created flowerbed in front of Buckingham Palace (Picture: The Royal Parks/Greywolf Studios/PA Wire)

The NHS turned 72 last Sunday. It’d be easy to say “It’s not the NHS it used to be”. But of course that’s true – healthcare in 2020 is radically different from when I qualified in 1992, let alone when the NHS was created in 1948.

A rising tide of concern about how well the NHS was coping generally has, for the last few months, changed into an appreciation as to how well it has coped during Covid despite the problems we know it had.

Let’s not forget, before Covid the NHS was close to breaking in places under the weight of what was expected of it.

Covid may have distracted us from that, but it also represents a real chance to ask what the NHS needs to do and needs to be for and not return to that unhappy place.

That is why I believe that a national conversation on the future of the NHS, between the Scottish Government, healthcare professionals and the public, is long overdue..

So what needs to change? The thing about the NHS is we all have our own often disparate views. There’s merit in those views even if they don’t always agree. But the need to hear those views seems clear.

Throughout the pandemic, there’s been an outbreak (pun intended) of honesty and plain-speaking from many politicians and health leaders alike which the public has clearly responded to, appreciated and repaid by keeping their side of the bargain during lockdown.

That’s why we’re edging towards a much better place with Covid in Scotland after a dark time in March and April when many people became very ill, and many did not survive the disease.

If honesty works, then we should keep being honest, as people rightly expect the NHS to return to delivering a fuller range of healthcare.

A new sense of partnership between public, politicians and those who work in the NHS, fostered by recent events, has been prominent, but not universal, and there are worrying signs in some places of a return to old habits of command and control.

But the potential for a new collaborative way of working, and one based on need, not just targets, is clearly there, and enough to give me some hope that change for the better is possible.

So we need more honesty. Honesty about necessary staffing, not soundbites about record staffing. Honesty about funding and what we can do with what we have, and what we could do if it was better, and what it is we want the NHS to be and do in the first place. The NHS cannot be a shopping list you just keep adding to.

Let’s not forget that the pre-Covid NHS had developed some bad habits in many places – sometimes turning the inability to meet political demands into inappropriate behaviours towards individuals and healthcare teams when those demands could not be met.

Whilst this year marches on with our focus on Covid and its effects on society, not just healthcare, we also can’t forget there’s a Scottish parliamentary election next year, so we need the conversations before that to be less about easy soundbite-driven point-scoring, using the NHS as the traditional political football. In unprecedented times, we need an unprecedented approach.

So if you want my view (amongst all the others), we need an NHS that focuses on individuals – staff and patients alike – and their welfare, not just numbers and throughput and targets. It’s got to be more about the quality than the quantity. And everyone concerned behaving better, if I can put it simplistically.

The NHS may be older, but to keep it healthy we need to get wiser about how to do that.

Dr Lewis Morrison is chair of BMA Scotland

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