A Royally Fit NHS

Nicola Biggerstaff

Healthcare in this country has been a tale of two systems for decades now. If you need healthcare, but cannot afford to pay for it, you will still receive it at no cost. But the when, where and how is a twisted mix of postcode lotteries and blind luck.

If you can afford to pay for it, you will receive first rate care and support, available at your fingertips at any time, as around 300,000 cancer patients in UK have over the last five years. And while of course we all wish King Charles a speedy recovery from his own cancer diagnosis this week, it highlights the issue of the disparities that exist in our supposedly equal healthcare system.

While it has not been explicitly stated, the mere fact that His Majesty has started treatment within days of his diagnosis would tend to suggest he has not been put on a waiting list, and is likely receiving the same high quality of treatment and care that allowed his mother to live until 96, his father until 99, his grandmother until 101, and even his aunt until 71 despite her chronic smoking and excessive drinking.

The average life expectancy for the rest of the UK is around 80. In Scotland, it’s 78. In some of Scotland’s most deprived areas, it's as low as 68. When this week it was revealed the number of people on cardiology waiting lists in Scotland are at their highest ever, and the Institute for Fiscal Studies (IFS) has debunked the Scottish Government’s claim that healthcare spending is on the increase, it’s time to ask if our NHS can be salvaged from this current state of disrepair.

At time of writing, a close relative of mine has been waiting over two months just for a consultation on a (thankfully, small and non-malignant) skin cancer. But we all know several stories of relatives and friends whose illness went undetected for too long, leaving only intensive and invasive treatment options available to them, or worse.

They tell us to get checked early if we suspect a cancer, but what is the point if that’ll just leave us at the bottom of an ever-growing NHS priority treatment list until it’s too late anyway?

According to Public Health Scotland (PHS), from July to September last year no NHS boards in Scotland met the 62-day standard, in which 95% of patients should wait no longer than 62 days from referral to treatment of any cancer, with around 72% of patients starting treatment within the 62-day window in Scotland. The 31-day standard, in which 95% of patients should wait no longer than 31 days between the decision to treat and the beginning of cancer treatment, was met by eleven of Scotland’s fifteen NHS boards.

I remember growing up and hearing the statistic that one in four of us will get cancer in our lives. Then, it was one in three. Now, it’s one in two. Half of us will get cancer in our lifetimes. And while treatments are always improving, and outcomes are hopeful for those who do receive treatment, if we do not get a grip on managing our health service effectively now, this waiting list shambles will only become compounded by the increasing number of diagnoses.

Even before Covid, the disparities in outcomes were clear, with cancer deaths in Scotland 61% higher among those from lower income households. We cannot be expected to improve health outcomes if we do not tackle the root causes lying in poverty and poor housing, and the associated stresses this places on lower income households, leading to higher rates of excessive alcohol consumption, smoking, poor diet and mental health issues, all of which contribute to skyrocketing rates of cancer diagnoses in less wealthy communities.

While we cannot fix poverty overnight, there are things we can put into motion now to deal with the bureaucratic, managerial culture in Scotland’s NHS which wastes precious time and resources which some patients, particularly cancer patients, simply cannot afford.

We should look to systems like Denmark, whose similar policy of diagnosis and treatment within four weeks respectively has undoubtedly saved countless lives. And yet, their healthcare spending as a proportion of GDP is less than we spend here in Scotland. So where is all this money going, if not into saving lives?

Waste and capacity issues in Scotland’s health service have been well covered in our Health chapter of Sorted, but they’re worth reiterating. Trusting clinical staff to make independent choices that they know will benefit their patients will remove a lot of the red tape which contributes to these delays in treatments. A clinician waiting for their manager’s manager’s manager to sign off on a treatment plan that they know will be effective is a waste of everyone in that chain's time, time that they could be spending attending to more of the patients in their care more attentively.

The real sickness here is the way our NHS has been ran into the ground at the whim of politicians for the sake of their own agendas. We deserve better than this, and Common Weal’s policy will ensure we all receive healthcare that's fit for a king.