Leaders: NHS in need of tough love and a new direction

MONEY is tight but even if more can be found, it would not be a panacea for all the health service’s woes – what is needed is reform

The Scottish Government has to be bold in reshaping the NHS to better respond to the needs of patients. Picture: John Devlin

Of the many issues that will define 2016 and provide a critical test for the Scottish Government, reform of the National Health Service is a stand-out.

Problems are increasingly manifest. Last year 15 operations a day were cancelled in the NHS in Scotland. Patients are struggling to secure timely GP appointments. “Bed blocking” is a recurring issue, while the service struggles to recruit doctors.

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Nor do the problems stop at the hospital gates. In the first half of 2016 the long-urged integration of health and social care takes effect amid concerns about the planning of the reforms, delivery standards and questions on funding.

Any doubt as to the scale of the problems for the NHS in Scotland is dispelled by the latest warning from the British Medical Association. It says Scotland’s health service will face “significantly more pressure” in the coming year despite a budget increase. With Holyrood elections due to take place in May, BMA Scotland chairman Peter Bennie called on Scotland’s political leaders to focus on the “serious challenges” the NHS now faces. In addition to the number of jobs vacant, the funding gap faced by the NHS and a growing number of unfilled consultant, speciality doctor and GP vacancies cannot be ignored.

In previous years it may have been easy to wave this aside as little more than a seasonal cri de coeur for more money. But it comes despite Westminster commitments to ring fence the NHS from government spending cuts, pledges of more money and only two weeks ago an announcement from Deputy First Minister John Swinney that the NHS would receive almost £13 billion in 2016-17 under his budget plans. This, says the BMA chairman, would only help prevent the current funding gap from “growing further”.

What is abundantly clear is that yet more money – even if this could be found – is not a cure-all for the ills of the NHS. What now needs to be grasped is radical reform.

In many areas the NHS does provide an excellent service. Few doubt the dedication and professionalism of doctors and nursing staff and the heavy demands in terms of working hours. But the Scottish Government has to be bold in reshaping the service to better respond to the needs of patients, delivering care where and when they need it, while making better use of resources.

It also needs to ensure that reforms are delivered in a timely and effective manner. The litmus test is that patients need to see a genuine difference rather than impressive-looking reforms with rows of ticked boxes. That is not always the same as an improved experience for patients.

Nor should the bold sweep of reform overlook the contribution that patients can make. Penalties for missed appointments should not be ruled out. Nor should the service shrink from tough action to mitigate the crowded and sometimes chaotic scenes in casualty departments on weekend evenings as professionals have to cope with the influx of alcohol abusers. All round, this is a service now in serious need of tough love.

Happy to be miserable on Monday

Ready to be miserable? Welcome to post-Christmas Monday. Today has been billed the worst day of the holidays as the Christmas comedown kicks in before the New Year pick-me- up.

But is Miserable Monday all that it’s cracked up to be? Consider the counter-factual.

For many this is a day to be warmly welcomed.

It’s a desperately needed break from the raucous battleground that the home has become – relatives fighting over which TV film to watch, noisy computer games with full-volume destruction of the entire solar system planet by planet, the constant accretion of dishes, cups, glasses and bottles that have to be dealt with.

Millions will return to work today, gloomy to all outward appearances but inwardly suffused with a warm glow of comfort at the quiet normalcy of life. Low-speaking voices, no fighting children, no horrible festive jumpers with flashing lights – and no Christmas TV commercials blaring in the background.

Yes, it’s a day of dull routine procedures. But there can be few experiences more pleasurable than keeping one’s finger pressed down on the “Delete” button and watching hundreds of out-of-date e-mails disappear.

Then there’s the comforting realisation that, when you break for coffee, it’s just one disposable beaker to deal with – no mass catering for awkward and fussy people.

When you arrive home you can moan about how horrible the day has been and how a large gin is absolutely required.

Oh, and then dream about the long extended break for Hogmanay.

Miserable Monday? Terrible, isn’t it?