Why our health service is in a critical condition

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THEY queued for hours and in all weathers and couldn't quite believe they wouldn't have to pay. People who had been suffering silently for years because they could not afford a doctor came in their droves because, for the first time, the advent of the NHS meant they were entitled to free treatment.

But since its inception, the manner in which the NHS has been run has been the subject of continuous scrutiny and criticism.

Indeed, during a recent interview with the Evening News, our new Health Minister Nicola Sturgeon described the past eight years of the NHS as a "wasted opportunity for Scotland's health service".

Ms Sturgeon is now in control of an NHS with an overall annual budget of more than 10 billion, with spending per head of population currently at 2019 (this compares to 1839 in England).

And while she admits there have been "improvements" since devolution through a boost in investment, she maintains that this "has not translated enough into patient care".

She adds: "I am very keen to look forward and build on what is going well, as well as taking action to right things I thought were wrong. There will be a very different approach."

It is inevitable that tough and unpopular decisions will have to be made that will include dispersing or centralising some services. Ms Sturgeon has moved to reassure patients that paediatric cancer services will remain at the Capital's Sick Kids Hospital and the future of St John's Hospital in Livingston is secure.

But the burdens on the NHS, including an ageing population and impending constraints on junior doctors' working hours, means that tough decisions will have to be made.

"People want everything delivered locally but some services will need to be centralised," warns Ashok Jacob, a consultant cardiologist at St John's Hospital.

"The challenge will be to educate and persuade people to accept the loss of some local services and possibly entire hospitals.

"However, this will need to be balanced by an improvement in transport links and subsidies for the less well off. Special considerations will need to be applied in rural communities."

The health of the nation is also changing and modern problems like obesity are described by Dr Jacob as a "national disaster".

He says: "Our children are fatter than ever and they will take with them into adulthood a significantly increased risk of diabetes, high blood pressure and cardiovascular disease," he says. "This will place a substantial burden on the NHS."

As each decade has passed, the NHS has seen great change and has benefited from the enormous advances in medical science that have taken place. In modern times, demands are understandably made for the wonder drugs that have the power to cure and prolong quality of life.

But the costs are high and the British Medical Association has gone as far to say that eventually treatment could become streamed into two lists - one that patients should be entitled to and another that will be down to the discretion of health chiefs.

Another costly legacy is that of the private finance initiatives (PFI) that paved the way for new hospitals like Edinburgh Royal Infirmary that was built to the tune of 183 million.

The SNP is strongly opposed to the deals which have resulted in health boards paying high premiums to private contractors and a loss of control when problems, such as poor cleanliness, have occurred.

"PFI is not value for money," Ms Sturgeon told the News. "My views are well known on this and this issue is something we will be looking closely at. There are a lot of hard lessons to be learned from the Edinburgh Royal Infirmary."

With new ventures already on the drawing board, such as the planned Royal Hospital for Sick Children in Edinburgh, there will be great interest in the funding alternative.

The SNP has suggested holding NHS assets in trust and raising public bonds to finance investment in a scheme known as Scottish Futures Trust.

Public health policy expert Mark Hellowell, of Edinburgh University, believes this could prove cheaper than PFI.

He adds: "NHS Lothian currently spends more than any other health board in Scotland on payments to private companies under PFI contracts.

"Last year, it spent 46.1 million in PFI charges. The board has, in addition, some very large capital investment plans in place, including an ambitious proposal for the Sick Kids Hospital in Edinburgh.

"If brought to fruition, these are likely to push annual PFI expenditure up to around 60m a year. With such high infrastructure costs, the financial viability of NHS Lothian would be in doubt."

NHS Lothian employs more than 22,800 people and recent statistics have shown that the number of staff in 2006 rose by 2.6 per cent compared to the previous year.

In September of last year, there were also more than 3600 administration, clerical and senior management staff employed by NHS Lothian - a reduction of just over 100 posts compared to the previous year.

And while progress is being made to streamline management, there has also been an 11 per cent increase in the number of nurses and midwives employed in the region.

But despite this, morale among some sectors of the workforce remains low - something which the Royal College of Nursing has expressed concerns about after one of its surveys showed that only 30 per cent of nurses thought there was sufficient staff to provide a good standard of care.

RCN Scotland board chairwoman Jane McCready recently called on NHS boards to employ "appropriate" numbers of staff. "There is still much to do," she added.

Under the scrutiny of former health minister Andy Kerr, enormous time, money and effort was invested in showing that progress was being made to reduce patient waiting times.

But there was also much criticism of the way the statistics were collated and, earlier this year, it emerged a record 6000 patients in the Lothians did not have the right to be treated within 18 weeks because they had been switched from the main waiting list on to the controversial back-up Availability Status Code (ASC) list.

As well as pledging to abolish these "hidden waiting lists", the SNP is also set to send a hit squad into Lothian hospitals to speed up treatment times.

Many patients - one third of bowel cancer patients in the Lothians, for example - are still waiting more than two months for treatment despite improvements in waiting times.

This is something which Ms Sturgeon has said is "simply not good enough".

And Elspeth Atkinson, the director of Macmillan Cancer Support agrees.

"The emphasis placed on the importance of waiting times cannot be overstated, nor can the importance of the availability of high quality services and treatment," she says. "They are both vital aspects of cancer care which Macmillan continually campaign to improve. "Reduced waiting times can make a difference to the outcome of a cancer diagnosis and also reduce the anxiety and distress associated with a long wait for a diagnosis."

Bevan's vision went on to revolutionise global care

THE National Health Service is one of the original three national health systems created after the Second World War and was unveiled by then-Health Minister Aneurin Bevan, usually known as Nye Bevan, in 1948.

Paid for via a system of national insurance, the newly created NHS would, for the first time, bring together hospital and community health services under the umbrella of one organisation.

Others followed in the UK's footsteps and now most developed European countries boast a health service provided to everyone regardless of their ability to pay. What distinguishes the NHS from other public healthcare systems in Europe is that the organisation employs its staff directly.

Arguably, France has the best health system in the world, with compulsory government funded health insurance with nominal fees. A similar system operates in Italy, which has the second best, according to the World Health Organisation.

Other examples include the Medicare models of Australia and Canada. Publicly funded institutions also exist throughout Latin America.

While publicly sponsored and regulated health care is widely available in Europe, it is a different picture in the United States.

There, an estimated 16 per cent of citizens do not have any form of health insurance and, while some publicly funded programmes do exist in the US and provide for the poor and disadvantaged, these are, at best, patchy.

Massachusetts is attempting to implement a near-universal health care system by making it law that residents purchase health insurance. Similar systems are being considered in California, Maine, Pennsylvania, and Vermont.

In contrast to the developed world, health care in Africa is usually non existent or highly limited and under-resourced.

More and more patients going private

THERE has been a massive increase in the number of people paying for their own healthcare in recent years.

Edinburgh's private Murrayfield Hospital was forced to plan a multi-million-pound expansion after the number of self-funding patients increased by about 46 per cent in just two years.

Hospital chiefs drew up proposals for an MRI suite, where patients could be seen on the day they were referred by their doctor, rather than waiting for an appointment with the NHS.

Murrayfield's medical and surgical services include a breast cancer and bowel cancer treatment service, as well as specialist diagnostic facilities, surgeons, radiologists and nurses to help treat conditions ranging from prostate cancer to lung cancer.

The consultants at Murrayfield Hospital include those specialising in the treatment of arthritis, back pain and dermatology. Operations such as hernia repair and vasectomy are also available.

Surgeons specialising in cosmetic surgery also work there, offering services such as breast enlargement.

In another sign of the growth of private healthcare, earlier this year a development site for a new private hospital overlooking Edinburgh Royal Infirmary was put on the market.

An 80-bed hospital - set to rival the Murrayfield Hospital and cost around 30 million - will be built there.

Earlier this month, Bupa agreed to sell its 26-chain hospital arm - which includes the Murrayfield Hospital - to European buy-out firm Cinven for 1.44 billion.

Fewer outpatients wait longer for treatment

LAST month, NHS Lothian announced a 30 per cent fall in the number of people waiting longer than the national target for outpatient treatment.

The health board has been charged with ensuring all outpatients with treatment guarantees are seen within 18 weeks by the end of December.

A new report has revealed there were close to 1000 fewer patients on the official waiting list at the end of March, compared to the end of last year.

Big hospitals' saving target raised to 20m

LOTHIAN'S main hospitals have been ordered to almost double the amount of money they are saving over the coming year. The hospitals have been set a target of saving 21.7 million - compared to the 11.5m achieved last year.

Spending on agency nurses, taxi bills and drugs are expected to be cut as part of the drive.

Consultants will also be expected to treat more patients and steps will be taken to ensure surgery theatres remain busy.

Champions chosen to clean up Lothians' act

THIRTY NHS workers have been appointed "cleanliness champions" in the Lothians in the past two months.

Their job is to educate colleagues about best practice and spotting unacceptable behaviour in the battle against hospital superbugs like the potentially deadly MRSA.

Last year, ministers pledged 485,000 to tackle MRSA after the ERI was exposed as one of Scotland's dirtiest hospitals by a health watchdog.


• The number of nurses employed in the Lothians has increased by 11 per cent in the past five years.

• Figures released in January show NHS Lothian employed 10,309 nurses and midwives in hospitals and in the community, compared with 2001 when 9272 nurses were employed.

• Health chiefs in Lothian have slashed the amount of cash they spend on agency nurses. Last month it emerged that NHS Lothian spent nearly 11 million on agency nurses in 2003-4, but just 4m in 2006-7.

• One in five of Scotland's cancer patients are treated in Lothian. Some, however, wait more than two months for treatment - including one third of bowel cancer patients.

• Ward beds in Lothian hospitals have the second highest occupancy rate in Scotland - 86.2 per cent - for acute specialities.