Time for talking on the NHS is running out – Dr Iain Kennedy

Last week’s Parliamentary debate on ‘A vision for health and social care’, was a well trailed debate, and I was hopeful that this would finally be the starter gun for the Scottish Government’s long promised National Conversation.  Sadly, it was more a squeak than a bang, and left having created more questions than it answered. While I welcome the commitment to engagement it cannot become an excuse to delay reform of the NHS, it must be the catalyst, reforms need to follow and they must be swift.

The Scottish Government committed to a National Conversation in their budget statement in late 2023.  And to be quite frank our NHS, doctors, health and social care professionals and most importantly patients, cannot wait another year for a list of solutions.  The NHS is in crisis, it has been building for years, with the result that there is no longer any difference between winter and summer pressures - indeed pressure has become the defining feature of the health service with a huge mismatch between supply and demand. 

The crisis that the NHS operates in on a daily basis is not sustainable.  We are all too aware of what health and social care staff have sacrificed over recent years, and to continue to ask us to work in the conditions we do, facing moral distress and burnout is not right.  The conversation should encourage innovation and new ideas but ones that are deliverable and realistic, it should help to manage public expectation on what is possible within the resources we have available – or choose to make available.  For too long we have demanded more from our health and care services without stopping to take proper stock of the impact that this is having on those working within it – or what they and the system are actually capable of delivering.  The expectations being placed on doctors have continued to grow without consideration on the impact this has on wellbeing. As a consequence we are seeing doctors taking earlier retirement, leaving to work abroad or in some cases, after years of training, just simply leaving medicine.

It was good to hear all parties agreeing that the founding principle, of the NHS remaining free at the point of need, must underpin any reform. It was also right to hear a focus on a preventative agenda again.  It is long term reforms and culture change that will be vital in making our NHS sustainable for generations to come.  But urgent clarity is needed on what the Government means by ‘a series of engagements’, and to ensure it doesn't become a scaling back of the commitment made to a genuine, honest and open National Conversation. While the Scottish Government must lead on the conversation, someone independent of government should oversee and manage the wider discussions with stakeholders. There must be a consensual way forward, across all political parties; for too long the NHS has been used as a political football, with reforms being focused around electoral cycles and this needs to stop.

I hope that this is the start of timely discussions on expectations, capacity, sustainability and deliverable reforms but for those facing the daily stresses and strains of working in health and social care it feels like further delays.

Dr Iain Kennedy, chair of the BMA’s Scottish Council