Politicians must rise above the current political instability and focus on what must be achieved in the health service if the NHS in Scotland is to flourish, BMA Scotland Peter Bennie has asserted.
In his speech to the BMA’s annual representative meeting in Bournemouth, Bennie commented that the NHS in Scotland faces a challenging climate.
“The health service is never out of the political spotlight. Over the past three years, the NHS has been front and centre in two referendums, the Scottish election, and two general elections. And we live with the on-going debate over the impact we can expect from leaving the European Union and the possibility of a second independence referendum in Scotland.”
Bennie also suggested that BMA Scotland will play a central role in ensuring that adequate healthcare services are delivered.
“Throughout this period of political instability, we at BMA Scotland have worked hard to deliver a consistent message to our politicians, urging them to focus on what must be achieved if healthcare is to flourish in Scotland.”
Bennie has identified a number of key areas where urgent action is needed.
These include the underfunding of the health service; a shortage of doctors to deliver adequate care to patients; a lack of resources to deliver a truly integrated health and social care service; and the lack of time for doctors to keep themselves up to date, to teach others, and to make joint decisions with patients.
Bennie believes that the pressure the health service has experienced has made achieving these changes more challenging.
The eminent doctor believes that healthcare professionals feel increasingly stressed and overburdened, and that patient care often suffers as a result.
“Scottish Government repeatedly says that there are more doctors than ever before – but this is simply ignoring a major risk to the health service, and it is demoralising and frustrating for doctors to hear time and time again. We need a realistic approach to workforce planning in Scotland which is based on an honest and shared understanding of the current medical workforce numbers, and an evidence based view of what future healthcare demand will mean for the number of doctors required. We need a clear and agreed approach to delivering and retaining this future workforce.”
Bennie particularly pointed to the publication of a major report from BMA Scotland, intended to point the healthcare service and doctors in the right direction.
“Our Chief Medical Officer has produced a report called Realistic Medicine in Scotland. This embodies the way we have all been taught to practise, and that we all try to practise. It is about sitting with a patient, discussing all the options, and helping them to decide what is best for them. It is about patients having clear information about their own responsibilities for their health, about the full range of help available, and about how to use it.”
Bennie also asserted that a process of collaboration is vital.
“It will only work if doctors and patients have enough time together to make joint decisions. And it will only keep working if doctors have the time to keep themselves up to date, and to train others to provide that expertise in the future. If the government and employers in Scotland are truly committed to realistic medicine, they need to demonstrate this by properly valuing the contribution and leadership role of doctors beyond the direct patient care they provide.”
The Labour party has announced a new initiative for the NHS which will shake up GP appointments in the nation.
As part of the scheme, all Scottish people will be able to claim an appointment with a GP within 48 hours of making initial contact.
Kezia Dugdale, the party’s Scottish leader, made the commitment when addressing her party conference in Glasgow.
Labour has promised that should it win the next Holyrood election in May that it will invest £500 million into primary care services in Scotland.
The money will be pledged over a five year period, and will form part of a £1.6 billion commitment to Scottish health spending.
With the SNP currently in control of the Scottish Parliament, Labour is facing a dual-pronged challenge from both the dominant party and the Scottish Conservatives.
The latter is currently aiming to become the second largest party in the Scottish parliament at the expense of labour.
Commenting on at the issue, Dugdale told party activists that Labour would increase funding for the NHS each year of the next parliament in real terms.
“Labour will use our powers to offer a real plan for the future of our NHS. Our Labour Party, that established the NHS in the 1940s, will be there to ensure that our health service is fit for the challenges of the 2040s. Because the NHS isn’t just another policy agenda for Labour it is part of who we are as a party, our pride in its creation inspires everything else we do.”
Dugdale is of the belief that primary care is absolutely central to the ethos of the NHS, and must be addressed if the health service is to reache its maximum potential.
“We can take the pressure off our hospitals by getting primary care right, delivering the NHS services people need in their communities. Instead of cuts to GPs we’ve seen in the last decade, our plan for the NHS will guarantee an appointment at your local surgery that you can book online within 48 hours.”
New powers over tax and welfare will be migrated to the Scottish Parliament in the near future, and thus the May election is considered to be particularly significant.
Dugdale outlined her socialist vision for the future of the country, and the potential for the Scottish government to assist in building a society in which “people aren’t fated to be rich or poor”.
Speaking to her party conference, Dugdale illustrated their ways she believes Scotland should change in the coming years.
“It isn’t a foregone conclusion that children born to poor families are half as likely to get to university as their wealthier classmates. It isn’t inevitable that the same child born poor will die nearly a decade earlier. It isn’t their destiny that poor children will be more likely to die in an accident, more likely to go to prison, more likely to take their own life when they are adults. We aren’t fated to to live in an unfair society. We can choose to be different. In this election we can use both our votes to do things differently.”
NHS 24 has announced the appointment of a new interim chief executive.
Angiolina Foster, the current chief executive of Healthcare Improvement Scotland, has been promoted to this new role.
Foster will take up this new position on 1st March following the departure of current NHS 24 interim chief executive Ian Crichton.
The new Chief Executive has been working in her previous position for nearly 2 years, having previously been the Director of Health and Social Care Integration in the Scottish government.
Foster will also continue to be the accountable officer for Healthcare improvement Scotland, with Robbie Pearson shifting into the position of Chief Executive.
Commenting on her new appointment, Foster was pushing out about the NHS 24 service.
“NHS 24 provides a vital service to people in Scotland every single day. I very much look forward to working with such a committed team and to helping them achieve the service improvements that the Future Programme will bring. My passion for the important work of Healthcare Improvement Scotland is undiminished and I know I am leaving it in very good hands until my return later this year.”
Foster will need to address some computing difficulties that have besieged NHS 24 in recent times.
In particular, the development of NHS 24’s new IT system, known as the Future Programme has proven to be problematical.
Both NHS and public sector computer projects in general are known to frequently run over budget, and the Future Programme has been no exception to this trend.
The system still has no launch date and is projected to cost £117.4m over 10 years; £41.6m more than the original £75m price tag.
Executives have already appeared before the Scottish Parliament to explain the problems with this system, and this is an issue that Foster will certainly be required to gain traction with.
Ian Crichton, the leader of National Services Scotland, took the time out from his role to explain to members of the Scottish Parliament some of the logistical difficulties.
“From the very start, the organisation vastly underestimated the scale of the work and the complexity involved in bringing such an ambitious programme into service, and it has struggled to cope. Although many mistakes have been made—and I can understand the committee’s extreme concern and dissatisfaction—it is important that you understand that NHS 24 has learned from them.”
Crichton also suggested that the situation had improved significantly from 12 months previously.
“It may not feel like that when you look at the issue from a distance, but if you look at each stage, when we have fallen down, we have picked ourselves up; we have made progress and got to the position today in which the technology works. We were not in that position a year ago.”
Despite the problems with the system, the Scottish government had nevertheless confirmed its continuing support for the project.
One of the top midwives in Scotland has suggested that every health board in the NHS should feature a maternal mental health midwife.
Gillian Smith, director of the Royal College of Midwives (RCM), highlighted the issue as a key area for progress as part of a series of suggestions to improve maternity care in Scotland.
Smith believes that instigating such a mental health system would enable the NHS to provide superior care for vulnerable women all over Britain.
It is notable that 10 per cent of Scottish women suffer from some form of depression and anxiety both during pregnancy and after birth.
Yet nearly three-quarters of the existing health board in Scotland feature no midwifery staff with accredited mental health training.
Smith also suggested that NHS bosses should increase the number of consultant midwives, while also focusing attention on the qualification of individuals working in the NHS in this department.
In particular, Smith believes it is important to emphasise that newly qualified midwives are offered permanent posts in order to secure the workforce on a long-term basis.
The RCM has previously warned that Scotland faces a “recruitment timebomb” as more than one-third of midwives in Scotland are over 50, with many opting to retire early.
Commenting on the issue, Smith stated that “Scotland’s maternity services are performing incredibly well and we can be justifiably proud of them. The government recognise the value of midwives and good maternity care to the quality of care women receive, and to the health of the women and the population as a whole.”
Smith went on to opine that there are many areas in which the Scottish health service can improve over its existing mental health provisions for women.
“However, there are areas where we can and should be looking to make improvements including better care for pregnant women with mental health problems and better continuity of care. Scotland also needs to be ensuring it secures its future midwifery workforce.”
Responding to the claims of Smith, Public Health Minister Maureen Watt made a commitment to update Scottish maternity services by the end of the calendar year.
Watt commented: “We are committed to ensuring mums and babies get the best care from our maternity services and hugely value the role played by midwives. It is thanks to the high-quality care they provide that more than 90 per cent of women rated their care during pregnancy and birth very positively in a recent survey.”
In addition, Watt also claimed that there is no shortage of midwives working in Scotland, and that the nation in fact has an excellent record in terms of dealing with women’s mental health issues.
With resources across the NHS severely stretched, staff often bear the brunt of the problems.
And new figures obtained by the Scottish Liberal Democrats indicate that this is beginning to have a significant impact both on staff health and absences.
Almost 600,000 working days have been lost across the Scottish health service over the past four years due to mental health problems.
The period assessed was 2011 to 2014.
Figures indicate that the number of sick days being taken due to ill mental health has increased consistently throughout the period.
This number rose from just over 86,500 in 2011 to almost 180,000 in 2014.
Among clinical staff, sick days rose from almost 33,000 in 2011 to almost 65,000 in 2014.
With the issue clearly a major problem for the health servive, Scottish MPs queued up to have their say in parliament.
Liberal Democrat health spokesman Jim Hume has called for urgent mental health support for NHS workers, branding the situation as potentially catastrophic.
Commenting on the situation, Hume stated: “Doctors, nurses and other NHS staff are working under enormous pressure and these figures show just what a toll this is taking on their mental health. These figures are stark. Hundreds of thousands of days have been lost as a result of mental ill health.”
Hume also spoke of the physical and financial cost of mental health issues for the health service, and indicated his belief that workers are being neglected by inadequate support.
“This is putting real strain on services and costing the taxpayer millions of pounds. More importantly, failing to tackle mental ill health in our NHS will impact on the many, many staff who are not getting the support they need.”
“We know that mental health services in Scotland are stretched, with reports that some young people have been forced to wait more than a year and travel hundreds of miles for specialist treatment. It is time that the SNP Government started taking mental health seriously.”
Jamie Hepburn, the Scottish minister for mental health, clearly an individual with a particular stake in this issue also commented on the issue.
Hepburn defended the efforts of the Scottish government to improve the performance of the NHS in this area.
“We value the dedication of our NHS staff extremely highly. They provide a first class service and we are determined to support them to do so. We have made clear commitments to improve mental health services and support for people experiencing distress and mental ill health. Last week’s budget included an extra £50m for mental health over the next five years – increasing mental health investment from £100m to £150m.”
Mental health and wellbeing has been a major focus of government policy in Scotland.
The Mental Health Strategy for Scotland: 2012-2015, published in August 2012, sets out the Scottish Government’s key commitments in relation to improving the nation’s mental health and wellbeing and for ensuring improved services and outcomes for individuals and communities.
Official figures have indicated that as many as 15 operations are being cancelled by the NHS in Scotland every day.
A report into the situation suggested that the cancellations can be attributed to a lack of capacity and resources.
Research conducted by the Scottish government indicated that in the region of 3,000 operations were postponed by hospitals in the six months until October.
Commenting on the issue, the Labour Party’s Jackie Baillie suggested that the existing situation is completely unacceptable.
“Our NHS is our most valued public service and it needs to have the resources to deliver the care Scots need. These figures are absolutely shocking,” Baillie stated.
Baillie also asserted that the Scottish government had failed a health service that is hugely valued in the nation.
“Now more than ever we need a health service free at the point of use based on patient need, not the ability to pay. Our NHS is our most valued public service and it needs to have the resources to deliver the care Scots need. These figures are absolutely shocking, and point to an NHS not getting the support it needs from the SNP government.”
Despite the concerns of the Labour opposition, the Scottish government insist that operations in Scotland which feature the highest clinical need are always prioritised.
Meanwhile, those of a less serious nature are rescheduled for the earliest possible opportunity.
But there is already considerable evidence in Scotland that the NHS has insufficient resources.
The 2015 NHS staff survey, published earlier this month, showed that one-third of workers did not think they had the resources to do their jobs adequately.
Baillie made reference to this situation in her statement to the Scottish parliament.
“Earlier this month only a third of NHS staff believed they had the resources and staff to do their jobs properly. Fifteen cancelled operations per day due to a lack of capacity show the reality of those concerns.”
Figures indicated that the number of cancellations in Scotland rose on a gradual basis from June.
This should come as no surprise considering the fact that the health service is more incumbered in the latter months of the year, owing to winter backlogs.
The NHS in Scotland faces similar funding difficulties to the English health service.
Finance secretary John Swinney announced £500 million of extra funding For NHS Scotland in his most recent budget, but this merely prompted accusations that Scotland is lagging significantly behind the rest of the United Kingdom.
Yet the Scottish government claims that the number of cancellations were relatively paltry compared to the total operations conducted, and also that clinical motivations were really involved in the ultimate cancellation.
“A very small number of operations are cancelled for non-clinical reasons. Health boards work to ensure disruption to patients is always kept to an absolute minimum, and any postponed procedures will be rescheduled at the earliest opportunity. We are clear with boards that operations for patients with the highest clinical need should not be cancelled.”
It was also pointed out that patient cancellations are by far the biggest cause of operations being rescheduled.
The Holyrood Health and Sport Committee has completed its research into specialist end-of-life care, and found that it shouldn’t be limited to merely cancer patients.
A committee of Members of the Scottish Parliament came to the conclusion that such care should be open to all patients.
In a damning indictment of healthcare in Scotland, the committee suggested that 10,000 people in Scotland are currently receiving insufficient access to palliative healthcare.
The commission also suggested that those with terminal illnesses other than cancer, the homeless and those with learning disabilities were less likely to receive palliative care at the end of their lives.
While decisions are currently made on a condition-based premise, the committee of Scottish MPs instead suggested that such critical decisions should be made on a case-by-case basis.
Increasing numbers of people suffering from terminal diseases are currently on the palliative care register, but the committee acknowledged that there is a serious issue with regard to access to palliative care for people with non-malignant diseases.
Scottish MPs concluded that palliative care should be a right not a privilege.
Commenting on the issue, committee convener Duncan McNeil, the Labour MSP for Greenock and Inverclyde, suggested that Scotland needs to take a much harder line on this issue.
“Our committee came to a firm conclusion that everyone who needs it should be able to access high quality, person-centred palliative care. We heard that this is not happening on a consistent basis and that people across Scotland have a different experience depending on where they live, their age and their condition.”
Prof David Clark of Glasgow University provided evidence to the committee which suggested that more than 10,000 Scots who could benefit from palliative care towards the end of their life died without receiving it.
This damning evidence was also backed up by accounts which suggest that homeless people and those with learning difficulties are significantly less likely to receive palliative care.
Health Secretary Shona Robison welcomed the report and stated that the Scottish government’s strategic framework on palliative and end-of-life care was due to be published by the end of the year.
“This framework will help ensure that everyone in Scotland – infant, child, young person or adult – no matter where they live and no matter what clinical conditions they have, will receive care from a health and social care system that recognises when time is becoming shorter. It will be supported by £3m funding over three years. The committee’s report will help inform the development of this framework.”
General health issues have been a major problem for Scotland over the last few years, with diminishing life expectancy in some of the worst hit areas underlining this trend.
In particular, it is been widely publicised that Glasgow is the city with the lowest life expectancy of any in the United Kingdom.
Figures released via a Freedom of information request have revealed that health boards in Scotland have paid private firms a record £82.5 million in order to treat patients.
This represented a significant increase from the £75 million figure for the same services acquired in the previous fiscal year.
Public spending on private healthcare has more than doubled since the turn of the century.
The increase in spending has occurred despite the statements of First Minister Nicola Sturgeon, who promised to reduce the level of privatisation of the NHS in Scotland.
Yet the picture gleaned from this information is that regional health trusts in Scotland are increasingly relying on private firms in order to carry out everyday operations.
Waiting time targets are thought to be a particular issue for the health service, and the major reason that the NHS is turning to private contractors.
Speaking on the controversy, Scottish Labour public services spokesman Dr Richard Simpson said: “These figures reveal the hypocrisy of the SNP around our NHS. They will campaign in elections against privatisation of our NHS while handing over increasing amounts of taxpayer cash to private health firms.
“Spending more taxpayer cash on private health services is an indication of the problems experienced by our NHS. It is clear they don’t have the capacity to deliver the care patients across Scotland need.”
Although the figures in Scotland are separate to those of NHS England, they can nonetheless be placed in the context of the health service suffering from massive deficits.
Already it has been predicted that NHS England will accumulate a deficit of £2 billion by the end of the financial year, and the suggestion that it is necessary for the health service to rely on private firms in order to deliver every day care further sullies this picture.
Yet Simpson also suggested that the level of expenditure could be cut via efficiency savings.
“The spending is also wasteful, as locum doctors and agency nurses as well as private procedures are inevitably charged at a higher rate than they would be in the public sector. Despite this increase in private sector spending, the SNP still can’t meet their own treatment time guarantee, which gave patients a legal right to be seen within 12 weeks.”
One must emphasise that Simpson is naturally motivated to some extent by political manoeuvring, but David Forbes, regional organiser for Unison, was certainly in agreement with his opinion.
“There has been an over-use of the private sector, who have been making obscene profits out of the public purse. That has been partly due to the unintended consequences of meeting very tight waiting time targets. Cuts are having to be made to balance the books because so much money is leaching out from the NHS into these private companies.”
The Conservative government in England has been accused of privatising the NHS by the back door, but these figures also indicate that regardless of political persuasion this remains a logistical issue across Britain.
In response to a recent British Medical Association (BMA) survey, a new piece of research suggests that there is significant room for improvement with regard to childhood nutrition in the UK.
The publication of the Scottish Health Survey for 2014 has underlined just how few children in the nation are consuming the recommended quantities of fruit and vegetables; a handy reminder after the BMA research of just a few weeks ago.
This extensive research of health trends in Scotland found that less than one-in-seven children in Scotland currently consume the recommended five daily portions of fruit and / or vegetables.
The survey regarding free fruit and vegetables was conducted on behalf of the BMA by Ipsos MORI, between 12th and 31st August 2015, with 2,000 parents interviewed online.
And despite the highly publicised five-a-day fruit and vegetable campaign, the study indicates that eating habits have not improved at all.
Since 2003, there has been no increase in the amount of fruit and vegetables being consumed by children in Scotland, with an average of 2.8 portions being maintained during this period. This is obviously little more than half of the recommended quantity.
The news comes in the context of the BMA publishing an online opinion poll of 2,000 parents across the United Kingdom.
This survey indicated that more than three-quarters would support the introduction of a free portion of fruit or vegetables for every primary age schoolchild.
Commenting on the disappointing figures, Dr Andrew Thomson, who sits on the BMA board of science, stated that the trends indicated by the Scottish health survey are rather worrying.
“This latest survey shows that Scotland is still falling some way short when it comes to making sure children are eating enough fruit and vegetables. Despite the growing cost of obesity related conditions to the NHS, there has been no real improvement to the average amount of fruit and vegetables consumed by children in Scotland for over a decade,” Thomson asserted.
Following up from the earlier research from the BMA, Thomson also suggested one possible way of addressing the chasm in fruit and vegetable consumption.
“Introducing an entitlement for all primary school pupils to receive a free portion of fruit or vegetables on every school day would be a real step forward and would help to ensure children in Scotland live healthier lives,” Thomson stated.
Although there are many factors leading to the obesity epidemic in the western world, certainly poor diet is generally considered to be the major contributor.
Despite various efforts to promote healthy eating among young people, there are numerous indicators which suggest that childhood obesity is a ticking timebomb in the UK.
Most recently, University College London researchers looked at data from more than 56,000 people born in Britain between 1946 and 2001, and found that the ages at which children are becoming obese continue to fall.
BMA Scotland has announced a new chair of its medical academic staff committee.
Dr Paddy Mark, a Clinical Reader and Honorary Consultant Nephrologist working at the University of Glasgow, has been appointed to this position.
Mark qualified for he profession back in 1999, and his current duties include heading the Renal Research Group at the University of Glasgow.
He is also employed as a Consultant at the Glasgow Renal and Transplant Unit at Queen Elizabeth University Hospital Glasgow.
Speaking about his elevation to this important position within the British Medical Association, Dr. Mark indicated his pride about the position, but also warned that the NHS in Scotland, and healthcare in general, faced some challenges in the foreseeable future.
“Scotland has long maintained an excellent reputation in medical education and research, but recently the committee has become concerned by the possibility of redundancies in some Scottish universities and changes to pensions, both of which could have serious implications for academic medicine in Scotland,” Mark warned.
Following on from these comments, Dr. Mark also indicated that employment issues within the health service could have a serious impact on the future of the NHS.
“The threat of redundancy may have a significantly adverse effect on academic medicine in Scotland by discouraging doctors from seeking academic careers and raise doubts about the value of research and teaching,” Mark opined.
In the meantime, the new head of the BMA body indicated that he would particularly prioritise fighting against any compulsory medical academic job losses, owing to the importance of such positions within the health service.
But he also warned that there is a risk of academics in Scotland being particularly vulnerable to certain legislative issues.
“Medical academics in Scotland will be disproportionately hit by USS (Universities Superannuation Scheme) plans to reduce pension contributions as they have to move to the USS after eight years, whereas those in England can usually choose to stay in the NHS scheme. This represents a major reduction in the remuneration package available to clinical academics in Scotland and would mean they are paid substantially less than their NHS colleagues,” Mark stated.
Concluding his comments on the subject, Mark pointed out that the potential of recruiting academic and healthcare staff within Scotland would be impacted by these issues, and resolved to play his role in having a positive impact on the issue.
“This would be a serious blow to clinicians in Scotland and a disincentive to young people considering an academic role. In the coming year, the Scottish medical academic staff committee will be pushing for alternative options to be explored to ensure doctors in training are not discouraged from seeking an academic career in Scotland,” Mark concluded.
In addition to the appointment of, Dr Paddy Mark, Dr Rebecca Riddell, a GP and clinical senior lecturer at the University of Aberdeen, was appointed deputy chair of the committee.
A Lanarkshire doctor has been elected chair of BMA Scotland’s Junior Doctors Committee (SJDC).
Dr Christopher Sheridan, a junior doctor working in Perth, will take up this prestigious position in the SJDC.
Sheridan is a natural choice for the position, as the experienced doctor grew up in the Clydesdale area of Lanarkshire.
Additionally, Sheridan was educated in Glasgow, having graduated from Glasgow University Medical School in 2009.
Sheridan is currently working as a Specialty Registrar in Psychiatry at Perth Royal Infirmary, and will continue this role while carrying out his new duties with the SJDC.
In addition to his new role, Sheridan also previously held the position of Deputy Chair of SJDC, leading on education and training issues.
Commenting on his appointment, Dr Sheridan was keen to underline the importance of the existing context for the NHS.
“This is a critical time for junior doctors in Scotland as the fallout from the Westminster Government’s threat to impose a new contract on junior doctors becomes clear,” Sheridan opined.
Sheridan was also keen to emphasise that the SJDC had a lot of work on its hands to address apparent government plans related to junior doctors in Scotland.
“While the assurance from the Scottish Government that it will not impose a new contract on junior doctors in Scotland is reassuring, the months ahead promise to be busy ones for SJDC as we work to protect trainees in Scotland and support our colleagues in England with the threat they are facing,” Sheridan asserted.
The new appointee also made reference to recruitment issues in the National Health Service, and resolved to play a significant part in improving the situation.
“With the NHS facing particular problems recruiting and retaining consultants and GPs and trainee positions going unfilled, it will also be more important than ever to ensure that the quality and standards of medical training are maintained. Patients need the reassurance that they are receiving the best possible care from a service delivered by fully trained doctors,” Sheridan stated.
The British Medical Association plays a major role in Scotland, effectively representing the voice of both doctors and medical students in the nation.
At a time in which it has been demonstrably shown that there is huge pressure on the NHS, and that this could be increased by the proposed seven-day working culture desired by the government of David Cameron, this is a challenging time for Sheridan to begin this post.