Scotland's NHS crisis is creating a two-tier system in which access to timely treatment is based on patients' wealth – Dr Iain Kennedy

The growth of NHS waiting lists means many patients who can afford it are choosing to go private

It has been a time of difficult news for the NHS recently. Firstly, it was confirmed that all new NHS Scotland capital projects had been put on hold by the Scottish Government, and then, just days later, Audit Scotland produced its 2024 annual report, which was, to say the least, staggeringly bleak.

It is massively concerning for patients as to what this report means for them and their access to healthcare, but we must also consider what this means for those working in a health service in such a desperate state. I’ve talked recently about moral distress and the effects on doctors and colleagues: constantly apologising for issues that are not your fault; struggling to do the best for patients despite the system being stacked against you; the impact on your work-life balance; the fear that the prevailing blame culture may leave you shouldering responsibility for things going wrong which are beyond your control. And that is without even mentioning the difficulties of working in crumbling buildings that are no longer fit for purpose.

Queues of ambulances seen outside NHS hospitals across the UK are a visible sign of the health service's 'waiting list' crisis (Picture: Leon Neal/Getty Images)Queues of ambulances seen outside NHS hospitals across the UK are a visible sign of the health service's 'waiting list' crisis (Picture: Leon Neal/Getty Images)
Queues of ambulances seen outside NHS hospitals across the UK are a visible sign of the health service's 'waiting list' crisis (Picture: Leon Neal/Getty Images)
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It is simply exhausting and the frustration we feel is very real. What we are experiencing now within the workforce are the repercussions of this: burnout amongst doctors and other NHS staff, who are retiring early, leaving entirely for another career or country, or simply not choosing a career in healthcare at all.

Recovery plan failing to cut worst waiting lists

What is even more frustrating about the current situation, and recent Audit Scotland report, is that none of it is surprising. Audit Scotland has raised concerns about the sustainability of NHS Scotland for years. Healthcare staff are still not working in a culture where they feel confident to raise concerns.

Waiting lists are growing, which will only further embed the two-tier system we have seen developing, where ability to access timely care is based solely on whether you can afford it. The Scottish Government’s recovery plan has failed to effectively address even the longest waits for treatment.

While previous reports generated some heated political debate, we are still awaiting the development of a concerted, focussed, overall health and social care plan that moves us away from the kind of piecemeal, politically expedient action we see at the moment. The Scottish Government has sleepwalked into the current situation by continually ignoring the warning signs that Scotland’s NHS, was and is, desperately struggling to meet growing demand.

And we have reached the point that we are now seeing the founding principle of the NHS, namely that it should be free at the point of need, threatened. This is the inevitable consequence of years of ducking the hard decisions and refusing to have a realistic and open conversation about what is possible for the NHS to provide within current resources.

We can’t wait any longer, now is the time to have an honest discussion about our NHS, and to build consensus around a plan for the future that will put it on a sustainable footing. Having a national conversation will require listening as well as sharing, and allowing everyone to come together, in a respectful environment of open dialogue. The value of a healthcare system, free at the point of need, is priceless, there isn’t anyone who hasn’t been helped by our NHS.

Dr Iain Kennedy is chair of BMA Scotland

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