THE phrases ‘National Health Service’ and ‘crisis’ have long been umbilically linked. A punishing and seemingly endless cycle of budget cuts, staff shortages and excessive waiting-times, to say nothing of people waiting for hours for a hospital bed or even for an ambulance, have guaranteed that the NHS is never far from the headlines.

Added to which are the fearsome costs involved in social care and in looking after an increasingly ageing population,

Furthermore, a resolute national effort to overcome the glaring inequalities in health would undoubtedly be of benefit to the NHS. Many attempts have been made to address them, going back to the influential Black Report of 1980, but with limited results.

As the King’s Fund puts it: “The case for tackling health inequalities is clear and overwhelming, and yet attempts to do so in recent decades have had mixed success. Crucially, none of these efforts have translated into the enduring focus on addressing health inequalities that is needed”.

Much-loved – though, here and there, distinctly frayed at the edges – the NHS is part of the bedrock of society. But in the aftermath of the catastrophic impact of Covid, opinions seem to be hardening against the service. It might now be time to have a full and frank debate on the NHS.

Healthcare spending now, after all, accounts for the biggest proportion of the Scottish Government budget; a record £18bn is being devoted to health and social care in 2022-23. People, not unreasonably, want to know how it their money is being spent and whether the service is getting worse.

Across the UK, according to a British Social Attitudes survey, public satisfaction with the NHS slumped by 17 percentage points between 2020 and 2021, to 36 per cent. It is the lowest level recorded since 1997 and the largest year-on-year drop in the survey’s history.

The pandemic, of course, tested the resilience of the NHS as never before, with consequential impacts on care and treatment in many areas – but many of these problems existed long before ‘Covid’ and ‘lockdown’ entered the everyday discourse.

Some 40 years ago, the left was insisting that the Conservatives under Mrs Thatcher were aiming for a two-tier service, with the private sector catering for the “wealthy and healthy” and an “inadequate and demoralised” NHS for everyone else. Are we now edging ever closer to this?

New figures disclose that the number of patients in Scotland funding their own treatment has climbed by 68 per cent since the pandemic. Between last July and September, 4,700 people paid for operations, tests, and other procedures at private hospitals, up from 2,800 for the same period in 2019.

Across the UK there was a 167% increase in people self-funding hip replacements in 2021 compared to 2019, along with a 127% increase in self-funded knee replacements in the private sector and a 63% increase in self-funded cataracts procedures.

These numbers might be relatively small but as dissatisfaction with the NHS grows, and as waiting-lists show little sign of being diminished, more and more people will be going private. It is not, of course, an option open to everyone; but a YouGov poll suggests that more than one in five of us may be more likely to consider private healthcare since the pandemic.

The problems within the NHS are serious, and getting worse. As our health correspondent has reported, more than 5,000 patients have been waiting for more than two years for an inpatient or day-case procedure on NHS Scotland, amid cuts to elective surgery triggered by the pandemic.

Waiting times in excess of two years have gone from something that was virtually unheard of before the pandemic to a problem affecting almost one in 20 patients on the inpatient and day-case list.

The Scottish Government has plans to tackle in-patient and day case activity to 20% above pre-pandemic levels by 2026 through a network of nine dedicated elective hubs, with an extra 1,500 staff ; soberingly, however, Audit Scotland has queried whether the plan can actually work.

There are many other issues affecting the NHS, including waste and bureaucracy. Staff morale is another: many workers report being exhausted by the demands made of them. As Adam Kay, the former doctor who wrote the bestselling book, This is Going to Hurt, said recently, the NHS is currently short of around 100,000 staff, with more leaving daily, “burnt out after an unimaginably tough few years”.

Against all of that, it has to be admitted that some good things have been achieved: the building of new hospitals and increased use of online consultations and pharmacies. But the problems remain – a lack of hospital beds, lengthening A&E queues, lack of care-home capacity – and as they continue to fester they will drive more people to dig into their savings to go private.

A new strategy is needed.

Politicians of every stripe have toyed with the health service, particularly as election time nears. As a rule of thumb, voters have little way of shaping NHS policy other than by casting a vote in the polling-booth. But that scarcely counts as a substantive contribution.

On the other hand, millions of us have first-hand experience of the NHS, in all its blessings and faults. Could the Scottish Government organise a network of town-hall meetings, online meetings and prime-time television debates in order to solicit the views of Scottish people?

Such views could help inform a new national strategy. We would at least have the satisfaction of knowing that our opinions, honed at the business end of hospitals and doctors’ surgeries, have not been overlooked.

We urgently need a serious national conversation on what we expect from our NHS. We need to determine what we expect from its doctors, specialists and nurses; we need to assert just how much we are willing to pay. Our politicians need to be upfront with us, and keep argument to a minimum, and perhaps manage our expectations. It sounds like a tall order, but as a relatively small and nimble country, with an articulate population, it need not be an impossible one.



Back on the rails

THE nationalisation of ScotRail by the Scottish Government is to be welcomed. While ministers have not covered themselves in glory in strategic planning matters, this is their chance to prove the sceptics wrong. Scotland needs an ultra-modern railway to boost the economy and tourism and to meet climate-change targets. Can we look forward to electrification being accelerated, to routes being re-established and the country being opened up? We can but hope.