AS A general rule, the word ‘apocalyptic’ is not something you wish to see in the context of waiting-times in Accident and Emergency units. And yet, there it was in black and white, in a report in these pages just three days ago.

“The current state of waits in major A&Es”, said the co-author of a paper on A&E mortality rates, “is apocalyptic, and we are seeing neither honesty about the numbers nor any good ideas about how to improve them”.

The remarks by Dr Steve Black came as our health correspondent, Helen McArdle, disclosed that some 4,000 patients spent more than 12 hours in A&E in June, as waiting-times remained disturbingly high.

On the same day McArdle reported that the number of planned operations – elective inpatient/day case procedures involving hip and knee replacements, hernia surgery, cataracts – being conducted in Scotland is more than a quarter below the levels seen before the pandemic struck. Delays to new elective hubs are partly to blame.

It seems as if we have been here before, as indeed we have. Ambitious, well-intended plans lagging behind schedule. Worn-out staff, their eyes red with exhaustion. Morale sinking fast. GPs under pressure to see more and more patients. Lives being put at risk. Warnings being ignored about chronic underfunding, and a lack of hospital beds. An urgent need to address issues related to social care.

It has to be acknowledged that, at a time when the NHS is seeking to recover from its Covid-induced nightmare, plans are at least in hand to improve matters. But then an unsettling thought intrudes: if the situation is as bad as this in summer, how on earth can the health service cope if and when things get really bad in the depths of winter?

A big part of the problem remains Covid. It might not be making people sick to the same extent, so intensive-care units are not as overwhelmed as they once were, but the knock-on effects are still noticeable.

Hospital staff who deal directly with patients are expected to stay at home if they test positive. Covid- and non-Covid patients have to be kept in separate wards; if you have 10 beds in a ward but only five positive patients, five beds go unfilled.

In addition, roughly one in 10 beds is lost to delayed discharge, when patients are well enough to leave but are unable to get social care. Covid has a part to play here, too – social-care staff might be isolating, or an outbreak has shut down a care home.

But Brexit, and the wasteful roadblocks it has put in the way of overseas staff seeking visas, is another factor. Some care-home staff have fled for jobs in retail or hospitality; the money is about the same but the stress is much more manageable.

What can be done about the elective waiting-list backlog, when stretched resources are being prioritised to A&E patients? The situation becomes more complicated when you factor in the Omicron variant, which is much more transmissible than previous ones.

Does Covid need now to be managed differently in hospitals? Should isolation protocols be relaxed in, for example, non-cancer/critical care areas? Should routine testing of hospital and social care staff be halted? Should we go for the expensive and longer-term option of ramping up ventilation and air-cleaning requirements?

An alternative might be to change how we manage Covid in the community. Some scientists have suggested returns to masking and distancing, and more working from home; but Scotland kept those in place longer than England at the start of this year without making much difference. With Omicron it might be difficult to make much of an impact unless measures were stricter (which at this point voters probably wouldn’t tolerate).

The only other option is to massively increase capacity: more hospital beds for elective work, and more staff. But here, too, there are serious problems.

A new Commons Health and Social Care Select Committee report warns that the NHS and social-care sector are facing the greatest workforce crisis in their history. The report specifically relates to England and Wales but Scotland is enduring the same issues.

So far as clinicians here are concerned, retention is the key issue. Perhaps to their chagrin, their counterparts in such countries as Australia, New Zealand and Canada, the UAE, earn much more, and have a better work-life balance.

Those at the top end of their career are also being hit by pension taxes, which mean it makes more sense financially to either slash their hours or retire early. Some doctors in this category might have pension pots in excess of £1m; nevertheless, the issue remains a real source of grievance, to the point that it is causing the NHS an exodus of clinicians when it can least afford it.

And then there’s pay – in real terms doctors are much worse off than they were in 2010, and are angry about their 4.5% pay award.

One way to address the crisis might be to throw money at restoring doctors’ pay and get rid of the pension issue (something similar has already been done for judges) on the basis that staffing is the single biggest factor in helping the NHS to clear the backlog. Retention, after all, is easier than recruitment and on training up new consultants, which takes about 10 years. It is cheaper, too, than relying on agencies and locums to plug gaps.

The downside? If we channel huge sums into pay packets, we leave ourselves with less to spend on upgrading equipment, cancer drugs, building new hospitals. But it is an option worth considering.

In the long term, prevention and investment in public health should be a priority. Part of the reason why Scotland and the rest of the UK fared so badly during Covid were the glaring health inequalities and much worse levels of chronic illness, obesity, multi-morbidity compared to other OECD countries.

Though health spending doesn’t necessarily equate to better health – the NHS is merely dealing with illness once it has happened – investment in reducing deprivation would actually deliver a better return for our money in the long term. The NHS’s present situation looks grim, but profitable changes can be made if the political will, and funding, are there.


Well done, Eilish

IT was a moment of high emotion: Eilish McColgan storming to victory in the 10,000m in the Commonwealth Games with a record time and, a Saltire draped over her shoulders, running straight into the embrace of her mother, Liz, who had twice won the same event during her own career. The photograph of ecstatic mother and daughter is one we will remember for a long time. Well done, Eilish. All Scotland is proud of you.