NHS Scotland is under huge pressure with senior consultants quitting in their mid-50s and junior doctors struggling to get time to train – Professor Harry Burns
Hopes that high levels of Covid and flu vaccination might reduce pressure on the NHS this winter might now be in the balance.
If the Omicron variant is not suppressed by the vaccine, we may be back to where we were a year ago. It could be a few weeks before we see how effective existing vaccines are against this new strain.
An optimistic view might be that, although it is infectious, it is less deadly that than previous strains and the vaccines reduce the severity of the infection and limit hospital admissions. The patients on waiting lists will certainly be hoping for that.
Those waiting for important tests or surgery for painful problems are having a difficult time. However, the NHS has successfully dealt with long waiting lists in the past.
In 2002, waiting lists were long. Among the many interventions, the then Scottish Executive implemented was the purchase of a hospital from the Abu Dhabi Investment Company. It was renamed the National Waiting Times Centre and it set about tackling long waiting list for joint replacements and heart operations.
It is now the Golden Jubilee National Hospital, and it houses some of the most advanced orthopaedic and cardiac services in Europe. The NHS in Scotland undoubtedly has the will and resilience to recover completely once Covid is controlled. What is not certain, however, is if we will have the people to make that recovery happen.
Even before the pandemic, the British Medical Association was pointing out that the NHS workforce was overstretched.
In 2019, 222 panels convened to appoint consultants in Scotland had to be cancelled because there were no applicants or none of those applying were suitable. It seems that about 20 per cent of consultants were leaving the service or retiring in their mid-50s. Reasons for leaving were disillusionment with the job (70%), poor work-life balance (57%) and personal health and well-being (56%). These pressures have not improved with Covid.
The problem of consultant vacancies is made worse by the fact that junior doctors, who would normally replace the retiring consultants, are feeling equally pressured.
A long shift for a junior doctor is ten hours. Fifty per cent of juniors are working four consecutive long shifts. Half of them report never or rarely getting a 30-minute break during their shift. Three-quarters of juniors surveyed reported having concerns about their safety during a shift.
Some are having difficulty in getting access to training opportunities or even getting time off to sit exams which are essential to their progress to consultant level. I understand that some are even thinking of leaving the profession because they feel unsupported and burned out.
Many years ago, when I was a junior doctor in Sir Andrew Kay's surgical unit in Glasgow’s Western Infirmary, things were very different. There was great camaraderie. Doctors, nurses, physios, domestic staff and managers (we called them administrators in those days!) were all part of the team. We supported each other and our patients were well looked after by a dedicated and happy workforce.
NHS Scotland is a great organisation currently under a lot of pressure. Giving front-line staff more autonomy and making them feel valued is essential if the NHS is to recover soon.
Professor Sir Harry Burns is a former Chief Medical Officer for Scotland
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