By Gavin Tait

THE principle of the anti-Covid campaign has been to “save the NHS”. On the contrary, the policy has destroyed the NHS, which will not recover or be fit for future purpose without major strategic changes.

Prior to Covid the NHS in Scotland (NHSiS) was failing; waiting times targets were persistently missed, mental health services were almost non-existent, GP services are being abandoned, social care is bankrupt, A&E is in regular crisis, staffing levels are inadequate, and hospital building has been a catalogue of failures.

The present Sottish Government presides over all these failures, and does not appear to have any solutions bar platitudes and a Nelsonian eye. Debate about the NHSiS quickly descends into constitutional arguments. No matter how bad the NHSiS is, it is always “better than England”. The real situation is ignored.

It is likely when Covid 19 is vanquished, if at all, then another Covid 29, then Covid 39 will each appear in 10-12 years if not sooner, each more deadly. Thus a limited opportunity exists to make major strategic changes in the planning, staffing and estate of the NHSiS to prepare. For that to happen there must be an immediate moratorium on all major structural changes in the NHSiS, including the building of new or replacement hospitals which are presently planned on what are now out of date models.

Covid has closed elective cancer and surgical services for six months as it is impossible to prevent the virus spreading in general “take-all” hospitals. Furthermore evidence is available that patients who catch Covid after major surgery do very badly, with much higher death rates.

Recently several doctors have predicted that consequently waiting times for elective care will rise uncontrollably and many patients may never be treated, and many more will suffer and die than are taken by Covid.

For the future there must be a clear geographical separation between “hot” hospitals with A&E departments, which will have isolated units for infective patients, and “cold” elective hospitals for surgery and cancer care, to which no patients, staff or visitors are admitted who have not been tested regularly for the virus.

Presently there are plans in the NHSiS to replace two Ayrshire hospitals with one, and build a new general hospital in Lanarkshire, both of which plans are contrary to real future needs. Such planning should stop immediately until new models, based on a Covid future, are developed.

The other problems of lack of staff, severely disrupted training for nurses and doctors, increase patient expectations, staff stresses, and the rise in elderly patients with multiple diseases, must also be addressed.

The challenges for the future of the NHSiS are enormous and threaten the very existence of the service as we have known it. The Herald and many others have been calling for an honest debate on the future of the NHSiS, with no success. Such a debate cannot now be delayed; another Kerr Report? Covid 29 will come in a decade and if the NHSiS is unprepared the consequences will be catastrophic, and greater than those of Covid 19.

“Save the NHS” is a popular slogan, but emotional clapping for an institution is no substitute for rational planning, which will be uncomfortable and only the bravest of politicians can achieve. The original NHS was planned during a World War. Is the present Scottish Government up to the task, and can it take the public with it in this war?

Gavin Tait is a retired surgeon and former clinical director for trauma and orthopaedics, Ayrshire and Arran NHS Trust