Current waiting times at Accident and Emergency are worst on record, patient health outcomes in Scotland have never been grimmer. Healthcare staff are so overworked and undervalued they’ve had to strike, some for the first time in the history of their profession. What on earth went wrong in our NHS?
Primarily, management culture, profiteering, and private interests have infiltrated our NHS and slashed its ability to run services in the best interests of its patients. Capacity, both in the sense of resources and staff numbers, have been cut as a cost saving measure, created as a result of target setting by human resource-led managers with little clinical expertise. This lack of understanding in healthcare, that capacity is not a sign of excessive, unnecessary expense but of a healthy, functioning society, has gone on to justify rounds and round of cuts to services, stagnation of staff pay, and a deterioration in conditions for them and their patients.
Health is equally a social, community investment as it is an individual and medicalised state of body and mind. All factors which influence our health: genetics, environment, housing, education, food and exercise, socialisation and wealth are interconnected. Healing the nation would involve solving poverty which, while we have the solutions to economic and social equality laid out throughout Sorted, do not all fall under the scope of healthcare. Here we lay out our plans to provide a high quality, effective service which not only remains free at the point of need, but remains free of private interests, and exists to serve the needs of its patients in a way which also values and empowers staff to do so.
So how do we get this Sorted?
First of all, much like our proposals for social care, Common Weal believe that localised services which can be adapted to suit the needs of their communities are key to achieving healthcare which benefits its members. A new generation of local hospitals, more commonly recognised as traditional cottage hospitals, should be reintroduced as a measure to relieve the pressure on larger hospitals, which have been taking the brunt of the strain as more and more healthcare services are stripped to the bone. Many people are unaware of the services left available to them, where their local minor injury or out of hours clinic is located, and if they do know, they often can’t get there without phoning 111 first. These new local hospitals would serve as a place to allow patients the time to heal and recover, placing less pressure on the ever decreasing number of current hospital beds, as well as provide some minor services, such as X-rays and post-op recovery/rehabilitation services such as physiotherapy.
By giving patients the time they need to heal and recover, in an environment which doesn’t simply see them as a body taking up a bed space, they can expect to adjust back to their lives more quickly and be less likely to need further treatment for complications in the future.
These would be staffed by a new generation of health workers who would previously have been prevented from pursuing clinical or medical careers. The employment of Healthcare Assistants and Community Health Support Workers in the new healthcare landscape will
Management in hospitals should be clinically led, by those with the knowledge and experience required to understand the inner workings and dynamics required in their professional settings. This is why we propose that management is taken over by a Medical Superintendent and/or a Chief Nurse, who would be answerable only to their fellow staff. We also propose an overhaul of the Health Board network, instead replacing them with a network of locally elected Health Councils, comprised of clinical and non-clinical staff and some patients’ groups. These local councils would elect representatives to also attend a National Health Council, which would become the primary point of contact between government and the health service, reducing their bureaucratic interference and target-setting culture.
A mutually owned National Health Company would take charge of procurement to take vested interests out of our health service. It would seek to take advantage of Scotland’s world-leading life sciences research bases to acquire patents, produce generic medicines, and secure supply chains for resources that cannot or are not yet being produced here in Scotland, such as PPE.
Litigation costs are one of the largest drains on the NHS budget after procurement and treatment costs. Restrictive insurance practices prevent trained staff from performing minor routine procedures, like suturing or administering injections, despite being more than qualified to do so. A new Statement of Subsidiarity would put trust back into the hands of healthcare staff and allow them to perform their roles with the full support of their employers. The statement would set out guidance on the full extent to which certain members of staff can perform certain duties, expanded to include these otherwise minor procedures and encourage collective responsibility. This legal protection would also reduce litigation costs, supported by the creation of an Independent Health Service Reviewer,set up to investigate cases of malpractice and issue rulings, deciding based on evidence whether there is precedent for patients to pursue complaints.
Of course, these measures would be best implemented when Scotland has full control of its monetary and fiscal policy. That does not mean there are no measures that can be implemented now to improve conditions in the NHS for staff and patients. Measures like the latest accepted pay offer will always be welcomed, but the new administration must ask what else can be done to improve conditions, and bring us back to the world-leading standards in nationalised healthcare that the founders of our NHS had in mind.
Want to know more? Purchase your copy of Sorted: a handbook for a better Scotland here to see more of our solutions for healthcare. We are also working hard with our Health Working Group, comprised of experts from across the healthcare sector to produce a full and comprehensive policy plan for Common Weal. Keep an eye out for this in the coming months.