Opinion piece by Fiona Grahame
Established in 1948 the National Health Service has insured that people are provided with health care in Scotland free at the point of need. In Scotland eye and dental check-ups were made free in 2006 and prescription charges were abolished in 2011.
“No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means. ” Aneurin Bevin
Sometimes it is far too easy to forget what it was like before we had the NHS and when we had to pay for our medicines. The obsession with statistics, percentages of waiting times all bandied about by politicians is used to devalue the incredible service provided by our health system in Scotland.
With some exceptions, health policy was devolved to the Scottish Parliament with the Scotland Act 1998. The exceptions are:
- Xenotransplantation (i.e. the use of non-human organs for transplantation)
- Embryology, surrogacy and genetics
- Medicines, medical supplies and poisons – although decisions on the funding of
medicines are devolved
- The regulation of the health professions that were regulated prior to devolution (the regulation of newly regulated professions is devolved)
- Health and safety.
The delivery of health services is mainly the responsibility of Health Boards. There are 14 Health Boards for local communities and a further 7 which provide specialist services to the whole of Scotland.
In Orkney, as is the case across Scotland, Health and Social Care has been integrated. There are issues with the way this is working. What was seen as being an improvement to the delivery of services has encountered a number of problems. This is preventing the success of what should have been a sensible coming together in the delivery of local services.
History of the National Health Service in the Scottish Parliament
The First Government in a Devolved Scotland was a Labour/Liberal Democrat coalition. It started to reverse the increasing use of market economics which had been used by the Conservative UK Government in its approach to the Health Service. (And which is still the case in England). The 14 NHS Boards were set up.
There were also considerable fears at this time over the centralisation of services (sounds familiar). The then Health Secretary in the Scottish Government, Malcolm Chisholm, commissioned the Kerr Report which stated that:
“[The NHS] should deliver safe, high quality services that are as local as possible and as specialised as necessary” (the National Advisory Group on Service Change, 2005, p 64).
The SNP Government first elected in 2007 continued with the same structures set up by the Labour/LibDem coalition but also included pledges to bring down waiting times and increase accountability. Health Boards now have the following structure:
- Non-Executive Lay Members – appointed by Ministers after open competition
- Non-Executive Stakeholder Members – appointed and paid in the same way as lay members but are representatives of specific interests that must be represented on the Board (e.g. chair of the area clinical forum)
- Executive Members – hold a place by virtue of their employed position within the Board (e.g. Chief Executive or Medical Director)
The Patient Rights (Scotland )Act 2011 established the patient’s right to complain.
Over a third of Scotland’s budget is used to deliver our health service. Every year there are calls for increases in funding as new priorities are identified. Most recently an additional £500,000 was added to NHS24 Mental Health Funding of £1,125,000.
Three quarters of the total health budget goes to Health Boards. It is the local Health Board that determines how this is spent. The hospital sector accounts for over half of NHS Scotland’s spending with staffing and pharmacy costs topping the bill.
Issues Facing Scotland
Scotland has an ageing population this affects the type of services being provided but also workforce planning. Added to the concerns over staffing is the UK’s decision to leave the EU which will have considerable implications over the retention of EU nationals working in health and social care. Estimates are that this amounts to 3- 5% of current staffing.
Brexit will also affect the following:
- reciprocal access to healthcare (via the European Health Insurance Card and the Cross Border Healthcare Directive 2011/24/EU),
- the regulation of medicines,
- working hours of staff via the Working Time Directive (2003/88/EC),
- mutual recognition of qualifications and free movement of health and care workers,
- public health measures such as the Tobacco Products Directive (2014/40/EU
Regulation of the above will become the responsibility of the UK Government.
The Health Service in Scotland has some of the best data in the world.
Weekly statistics are published on performance for Emergency Departments and Waiting Times. How useful it is to have weekly statistics is doubtful? And Statistics without analysis is extremely questionable.
Anyway for those who like statistics, here are the figures for the week of 1st October:
- There were 27,154 attendances at Emergency Departments across Scotland.
- 92.7% of people attending Emergency Departments were seen and subsequently
admitted, transferred or discharged within 4 hours.
- 158 (0.6%) patients spent more than 8 hours in an Emergency Department.
- 31 (0.1%) patients spent more than 12 hours in an Emergency Department.
For the week ending 17 September 2017:
- There were 26,963 attendances at Emergency Departments across Scotland.
- 92.2% of people attending Emergency Departments were seen and subsequently
admitted, transferred or discharged within 4 hours
- 193 (0.7%) patients spent more than 8 hours in an Emergency Department.
- 40 (0.1%) patients spent more than 12 hours in an Emergency Department.
Our expectations for what can be delivered by NHS Scotland are extremely high. The media and many politicians use the published statistics and the incredible success of our health service to belittle the amazing work that is carried out on a daily basis by the service.
Cancelled operations are often used to criticise the NHS in Scotland but if you do look at the figures what it shows is that many operations are actually cancelled by the patients themselves.
There were 30,516, planned operations (figures for August 2017) .
- 1013 (3.3%) were cancelled by the patient;
- 966 (3.2%)were cancelled by the hospital based on clinical reasons;
- 523 (1.7%) were cancelled by the hospital due to capacity or non-clinical reasons;
- 79 (0.3%) were cancelled due to other reasons.
Our health and welfare needs are increasingly complicated as we become more aware of factors which influence our wellbeing.
“Most people in Scotland are overweight: 2 out of every 3 adults and 1 out of every 4 children. People with a healthy weight are now in the minority. Obesity trends are affected by age, gender and socio-economic status.”
“Obesity can have serious health consequences, such as cancer, type 2 diabetes, strokes and many other debilitating conditions. Overall, obesity can reduce average lifespan by up to 10 years.”
“In Scotland, obesity costs the NHS an estimated £600 million per year. It significantly reduces Scottish productivity and the size of the Scottish economy.” SPICe HOW CAN WE REDUCE OBESITY IN SCOTLAND?
Diet, lack of exercise, smoking and alcohol consumption are factors which many of us can take personal responsibility for. All four of these items result in huge costs to the Health Service. This is preventable. Why is it the case that we moan about the centralisation of services and yet we are so poor at taking control of our own personal health and wellbeing? Isn’t it time that instead of the continual carping criticism of what is an extremely successful health service that we instead take on the responsibility of what we can do in the way of keeping ourselves fit and healthy.
The Health Service in Scotland is not perfect. There are real issues around the delivery of integrated health and social care. Our Health Service is, however, something we should be extremely proud of. It is delivering a very high standard of care in a time of intense scrutiny by those who have forgotten what it was like before we had a National Health Service, by those who have a privatisation agenda and by those who are just political point scoring. The Health Service in Scotland is a story of success.
“The NHS will last as long as there are folk left with faith to fight for it” Aneurin Bevin
Reporter: Fiona Grahame