Change in direction and leadership needed to save Scotland's NHS, report warns

Serious change in direction and leadership is needed to save Scotland’s NHS, a report has found.

The review by Mike McKirdy, a retired consultant surgeon from NHS Greater Glasgow and Clyde and the former president of the Royal College of Physicians and Surgeons of Glasgow, warned “more of the same will not be enough”.

Mr McKirdy said the founding principles of the NHS were “becoming strained and frayed” and that current trends risk “entrenching a two-tier system where access depends increasingly on ability to pay rather than clinical need”.

His report found that since 2019 private healthcare admissions have boomed by 55%.

It also found that the median wait time for an NHS 24 call rose from nine seconds in 2014 to more than five minutes in 2020, before jumping to 22.5 minutes this year.

The report said private healthcare use had surged in recent years. PA Media

There has also been a rise in wait times in areas such as radiology which was 88% higher than in 2017 and endoscopy which was 36% higher.

Since 2007, more than 130 major health strategies have been published, Mr McKirdy found – the equivalent of one every seven weeks.

The report said that pressures on the NHS were having a substantial impact on health staff, who are around 50% more likely than the general population to experience chronic stress.

Analysis in the report found performance in Scotland’s NHS was declining on key measures prior to the pandemic and “the challenges in the NHS were not caused by the Covid-19 pandemic”, adding that it instead “exposed and enhanced” existing weaknesses.

NHS staff were highlighted as a key strength of the NHS but the report warned they were “at risk of burnout” and at times dealing with “problematic cultures that actively discourage the raising of issues or shut down concerns even when regarding patient safety”.

Mr McKirdy concluded that “the current challenges are not insurmountable, but they do require a fundamentally new approach” and that “serious change is needed in the direction and leadership of the health service”.

Speaking before the official report launch, he said: “The NHS is a treasured institution.

“Its founding principle – that care should be free at the point of need – remains deeply valued in Scotland.

“That it should be there for us at the start of life, all the way to the end, is a unifying and equalising concept.

“Its staff are proud of the work they do and the care they give is valued and respected by the public.

Mike McKirdy said challenges in the NHS were not insurmountable. PA Media

“Yet, as the service comes under increasing pressure, these principles are becoming strained and frayed.

“As confidence in the NHS to be available declines, so too the commitment to the sharing of the risk of ill health and the common good of our shared life is in danger of becoming lost.

“But, before remedy is possible, diagnosis is required. Therefore, this report considers many aspects of the NHS in Scotland, from patient access to the quality of services, the governance arrangements and productivity.

“It considers hospital activity, emergency and repeat admissions, delayed discharges, patient safety, avoidable mortality, preventive health measures, and inequalities in outcomes.

“The health system must operate within its own specific context, so the report also considers the wider health and inequalities within Scotland and the role of prevention.

“To deliver the outcomes needed, serious changes are needed in the direction and leadership of the health service.”

Scottish Labour leader Anas Sarwar said: “Our NHS is our most precious public service, but as doctors themselves have warned the very existence of the service is in danger.

“The situation uncovered by the McKirdy Report is one of governmental failure with Scots paying the price

“This landmark report shows the SNP’s utter failure to recover from the impact of the pandemic is because of their inability to modernise our NHS for the future.

“Enough is enough – we don’t need more undelivered strategies, we need bold and meaningful change to fix our NHS and to tackle the waiting list crisis.

“That’s why a Scottish Labour government will declare a waiting times emergency, cut NHS red tape and empower Scotland’s doctors and nurses.”

Scottish Labour leader Anas Sarwar warned the existence of the NHS was in danger. PA Media

Health Secretary Neil Gray said: “The evidence is clear that our NHS is turning a corner, with downward trends across nearly all waiting list indicators.

“Long waits over a year have reduced for five consecutive months, diagnostic tests have increased significantly, GP numbers are rising, and operations are at their highest level since January 2020.

“To suggest otherwise does a huge disservice to our outstanding NHS staff who are delivering thousands more appointments and procedures this year, supported by our record £21.7 billion investment.

“With NHS workforce numbers at an all-time high, we’ve launched our once-in-a-generation Future Medical Workforce project to shape future reforms in training, recruitment and workforce planning.

“Health is at the heart of our commitment to improve public services, we plan to invest in a range of reforms including shifting care from acute to community settings, dedicating £531 million to general practice over three years and expanding Hospital at Home capacity to 2,000 beds by end of 2026.”