How did NHS Scotland get to where it is now

Health Scotland
  • A growing need for private healthcare is a result of the NHS's current state of crisis.
  • The public service report from Audit Scotland is depressing to read.
  • Huge sums of money are being added to its budget, but nothing is being done to change it. The study examines the urgent need for non-financial changes.

Along with a gym and rooftop terrace, your apartment rental includes access to a virtual doctor within a little over 30 minutes, who will then quickly deliver your prescription.

It is not a gated, opulent, wealthy community of senior citizens in the US sunbelt, according to some marketing copy that was sent to me today, but rather a housing development in Edinburgh and several other British cities.

The "happiest and healthiest" residential communities are what Moda Living seeks to create.

Your GP is provided by a branch of the Lloyds Pharmacy network, and tenancy also offers you a 40 percent discount on private counseling, therapy, and wellbeing sessions to enhance your mental health.

However, this method of providing private healthcare is also taking notes from what is happening in the NHS and appears to be a sign of things to come.

Due to the NHS's shortcomings and lengthy waiting lists, more people are turning to private healthcare and two-tier systems.

Health insurance as well as self-pay options have both grown in popularity. Self-payment, without insurance, increased by 39 percent in the UK and by 84 percent in Scotland, according to data from a health data consultancy last year.

The most effective private health promotion has just been released by Audit Scotland. A depressing read.

It fails to account for the large number of people who seek help from the NHS during a crisis and find that its employees are excellent.

Instead, it examines healthcare data. According to the report, there are "extreme" and "severe" pressures, slow Covid recovery, declining cancer target performance, and "financial struggles.".

The government spending watchdog has previously brought attention to what it sees as the NHS's unachievable organizational and financial limits based on the way it is currently set up through Covid and before it.

It draws attention to health boards that are required to provide services far beyond what their budget can support. .

For instance, NHS Argyll and Clyde claims that it requires £13 million to meet its waiting time reduction goals. It will receive £7.8 million. Although it has been given £8.3 million, NHS Highland claims it needs £12.5 million.

NHS Scotland sign

Only three out of the 14 territorial health boards (aside from national boards for specialist services like training) are on track to break even this fiscal year, according to Audit Scotland. To put it another way, all the boards would need to make savings totaling £621 million to break even.

The fact that the service frequently follows a political schedule could be one of the reasons why the funding does not match expectations. The NHS Covid recovery plan was promised within 100 days of the 2021 election, it is noted.

Health boards were not consulted in order to fulfill that promise, according to Audit Scotland. However, it is on them to perform.

Targets are set at a high level. Health boards are called to appear and reprimanded if they don't. I've often questioned why anyone would agree to serve on them.

The Scottish NHS and social care system will receive more than £19 billion in funding in 2019, which is more than they were projected to get in 2026–2027.

It implies that other expenses are restricted. However, it continues to fall short of solving the service's issues.

The argument made by Audit Scotland is that there must be more to the solution than just money.

It urges ministers to better interact with the public and sends a clear message to the government about what the public is led to believe the NHS can offer.

Public health advancements play a role in that. The solution to the issue of supplying health services is obvious: decrease demand.

The supply issue can also be improved by having a healthier workforce.

Every year, Audit Scotland serves as a reminder to the Scottish government that hiring and retaining staff means making sure they are in better physical and mental health so they can meet those expectations.

Filling job openings in wards and clinics is one of the best ways to support those who work in the service.

This report cites data from a Royal College of Nursing survey that reveals 86% of respondents didn't think patients were cared for safely and effectively during their most recent shift. Approximately 63% of respondents said they were discouraged and negative about staffing levels, and 59% said the problem had sapped their morale.

62 percent of trainees were found to be at moderate to high risk of burnout, according to a General Medical Council survey of them. More than one in twenty health professionals take a sick day on a daily average.


The Scottish government is aware that there is not a help-seeking culture in NHS workplaces. Additionally, the watchdog asserts that more needs to be done for physical wellbeing, including more space for staff to take breaks, even though more mental health services are being implemented.

The cost of hiring agency nurses to try to fill some of those gaps is one effect. Since 2017, the cost of nursing staff employed by banks and agencies has increased by 93% to £321 million.

Another is that it costs money to try to hire people from abroad; a nurse typically costs £12,000, and an allied professional like a physiotherapist costs £10,000 on average.

NHS Highland asks, "Even if you can attract them, where are they supposed to live cheaply?".

Others worry about the removal of healthcare workers from underdeveloped nations where they are even more necessary.

For a number of years, the glaring message has been how woefully inadequate workforce planning is.

The GP issue is among the most glaring, but there are gaps throughout the entire service.

Many have left the industry or changed to part-time work. The number of "whole time equivalent" general practitioners, which takes into account those who work part-time, is down by 26% from 2017.

The creative solution is to hire more people to support GPs, and according to Audit Scotland, progress has been made since 2017. However, it is still seeking proof that the 3220 additional employees in these positions are having the desired impact.

It states that it is unlikely that the goal of 800 new GP hires will be met. On BBC Radio Scotland, Health Secretary Humza Yousaf stated that he has already received 250 applications. That is odd considering that Audit Scotland can only locate 113.

Humza Yousaf
Humza Yousaf, the health secretary, wants to bring more doctors of medicine to NHS Scotland.

More people can be trained for jobs in the health service as one way to accomplish this. In medical schools and nursing programs, more funded spots are being made available, but Audit Scotland reports worries about enrollment and attrition as well as a shortage of seasoned GPs to supervise trainees.

Back in 2012, Audit Scotland made recommendations to the Scottish government and NHS Scotland to enhance the caliber and volume of workforce planning data.

The report for this year states as its conclusion, "We have seen little evidence of progress with this.".

Predictably, opposition attacks on the Scottish government and Mr. Yousaf in particular used the watchdog report as ammunition. Whataboutery, as in "what about the situation in other parts of the UK?" is a common ministerial response.

That is a legitimate concern, but the comparison has a low standard. The NHS is having trouble recovering after the shock of Covid, despite having long emphasized the efficiency of maintaining capacity close to demand.

The Institute for Government was considering a similar set of issues for England on the same day Audit Scotland issued a critical report on the NHS in Scotland.

The healthcare industry has been impacted by "political instability and administrative paralysis caused by the defenestration of two prime ministers over the summer and autumn," according to its performance tracker, which serves as a scene-setter for the Westminster budget on March 15.

The independent think tank continued, saying that "winter pressures have combined with persistent issues in adult social care, hospitals, and primary care to result in the worst NHS crisis in a generation." Some members of the think tank's staff have held positions inside Whitehall. ".

The institute also notes that the UK government's approach to handling public sector strikes, when they occur, has not been successful and has likely further enraged the frontline staff needed to improve public services.

It claims that this has further weakened the agreement on public sector pay that Scotland and other pay review bodies were able to strike.

Doctors are discovering that the extreme measures and concessions that were required of them during the pandemic have not been rolled back as a result of these pressures. .

Edinburgh general practitioner and author Gavin Francis recently wrote in the magazine 1843 with a reflection on advice he received from the General Medical Council last November: "A sensible, supportive and necessary intervention in 2020, intended to reassure a workforce facing a terrifying pandemic, had, by 2022, become something far more sinister - an acceptance of a new status quo, and a chilling normalization of crisis."

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