Over the last 20 years the NHS has seen huge advances in the investigations we perform and the care we offer.

We detect and treat cancer at an earlier stage, improving outcomes and prognosis. We put stents into people’s coronary arteries to restore blood flow when they have a heart attack. We give clot-busting medication or remove clots from arteries to restore circulation when people have a stroke, saving brain tissue.

Novel drug treatments, targeting specific genes or disease markers, have revolutionised the treatment of cancer and chronic health conditions.

Average length of in-patient stay has fallen considerably, and we deliver more care in or closer to people’s homes. Many people now live longer in better health and avoid early disability, reducing requirements for long-term care.

As our care has evolved, so too has the workforce that provides it. We now work in skilled multidisciplinary teams to promote and enable person centred care. Extended roles for nurses, physiotherapists, occupational therapists, and healthcare support workers have been developed and the physician associate role created. There has been a significant expansion in medical consultant numbers.

And yet the NHS in Scotland faces its biggest workforce crisis and the very real prospect of collapse of key services. Nursing and midwifery vacancies are at record highs – as of 31 December, 2021, there were 6,674 nursing and midwifery vacancies across Scotland, a rise of almost 1,000 in three months.

Data collected by BMA Scotland last year show that 15 per cent of consultant posts are vacant and 45% of consultants in Scotland are considering retiring in the next five years. One in 20 physiotherapist and occupational therapist posts is vacant. Our remote and rural hospitals and facilities are often the most affected, increasing health inequalities for our citizens in these areas.

How has this come to pass and what can we do to rectify it?

We have not kept pace with advances in care and the huge rise in patient demand and expectation. Increasing health inequalities, complexity of care, an ageing population and inadequate workforce planning are key factors. Healthcare advances at such pace that even specialists struggle to stay abreast, and more investigations and treatments fall beyond the scope of the generalist.

Workforce planning has been inadequate. We have failed to widen access to education and an undergraduate degree remains out of the reach of most due to inequalities, lack of informed careers guidance and lack of financial support. Medical students in Scotland leave university with an average debt of around £28,000 and most rely on parents to support their education. Students with unskilled or semi-skilled parents have higher levels of debt. There is ample evidence that care provided by people from diverse backgrounds leads to better health.

Workforce shortages are long-standing, now exacerbated by Brexit and made even worse by the pandemic. Colleagues across healthcare disciplines regularly work with fewer staff present than there should be, and time to undertake patient care and activities which support care is squeezed.

Healthcare staff need time to engage in teaching and training, research and innovation to improve services. As these opportunities disappear, as leave is cancelled and as gaps increase, staff become burnt out. Patient care suffers. Colleagues leave the profession, reduce hours or take extended sick leave.

We are not training enough healthcare professionals to replace anticipated retirements never mind fill existing vacancies. We quite simply are not supporting our staff to ensure we have a sustainable, flexible workforce to deliver the high standards of patient care our people deserve.

Although medical school places have increased, this has not been matched by sufficient investment, and universities remain reliant on international students who may not remain in Scotland. Following graduation, postgraduate training opportunities have not been expanded or fully funded, limiting opportunities for medical graduates to progress to consultant or GP roles.

Scotland therefore remains a net exporter of medical students, failing to capitalise on its educational investment. A fully funded long-term training post expansion plan informed by data and healthcare need predictions is essential.

To begin to address this, Scotland’s NHS needs robust, data driven, independent workforce planning with clear projections of the numbers of doctors, nurses and other healthcare staff to meet future demand.

The Scottish Government has a real opportunity to show vision and strong leadership by developing and funding a long-term workforce plan with clear lines of accountability for its delivery. We must pay heed to the predicted continuing rise in less than full-time working across genders and we must be more flexible in how we deliver healthcare training and professional development as well as patient care.

We must ensure that training as a healthcare professional is accessible, achievable and equitable and that we offer and support career development. We must work harder to retain existing healthcare staff, to ensure they are supported in their roles and have opportunities to develop new skills or work flexibly.

Staff must be given time to teach, to train and to collaborate and innovate to improve services. We must look at punitive tax legislation which means that many doctors must drop hours to avoid penalties.

We must support our international colleagues to come to work in Scotland in mutually beneficial partnerships; we can learn much from each other and can provide training and development that colleagues can bring to their home countries on return.

Whilst we should continue to support the expansion of roles that can be undertaken by professions outside of medicine, we must bear in mind that consultants offer excellent value for money and provide necessary leadership and oversight of patient care. Evidence shows that consultant-led care reduces variation in care, patient harm, length of stay in hospital and unnecessary investigations and treatment whilst improving patient outcomes, satisfaction and experience.

To support our workforce, we must also look at how healthcare demand could be reduced. Bold leadership from the Scottish Government and collective action on the social determinants of health is essential. Cross-sector work to reduce health inequalities must be prioritised and properly supported with monitoring of progress and clear lines of accountability.

We must invest in public health, health education and primary care. We must support innovation in joint working and enable rapid improvements in digital communication between disciplines, within health and social care sectors and with patients.

The NHS has set important targets towards becoming a net zero greenhouse-gas emissions service by 2045 and this too must be central to future planning. Protecting the climate protects our people and the NHS too. And if we do not develop and fund a sustainable social care plan, valuing, developing and retaining staff, the NHS is certain to fail.

The face of patient care has changed considerably, heightened by the Covid pandemic.

The Scottish Government must seize this opportunity to re-imagine and improve our NHS, keeping its core principles of accessibility, equity, publicly accountability and being free at the point of access at its heart.

Marion Slater is a consultant physician and regional adviser (Grampian) for the Royal College of Physicians Edinburgh