Those who work tirelessly in the NHS know there is a crisis. Will the SNP now listen?

FOR a number of years now, the Royal College of Nursing Scotland has warned that the NHS faces a crisis north of the Border.

But today’s report by Scotland’s Auditor General lays bare the fact that the crisis in the NHS is now upon us – and the Scottish Government needs to take action.

Patients, families and staff are now seeing the effects of years of shortages and growing demand on the health service at a time when budgets have just not kept pace with the demands being placed on our NHS.

Every significant part of the NHS is covered by the Audit Scotland report – missed targets, financial challenges, growing drug costs and rising numbers of agency staff. There really is not an area in the NHS where the Auditor General is not raising a significant concern.

Six years ago, the Royal College of Nursing and a number of other organisations, including Audit Scotland, were warning what was going to happen with the problem of shrinking finances and rising demand.

It is frustrating for the public and patients that we are in this place now, reading this report today, when the crisis we had been talking about emerging then is really upon us now.

What we now need is a really clear and decisive response from the Scottish Government about this report that addresses point by point the many issues that the NHS is now trying to deal with.

If the NHS keeps on doing things in the same way, there is clearly not enough money going in and not enough staff to treat the growing demands facing it.

Everyone knows NHS health boards are struggling to balance their books – yet agency nursing costs have gone up by £7.5million in the past year alone. That’s an almost 50 per cent hike in one year to cover gaps in the nursing workforce.

Using agency nurses on a regular basis is not a sustainable way to manage a staffing budget or to make sure that patients get continuity of care by seeing the same team on a day-to-day basis. Yet boards are increasing their spending in this area because of staff shortages. There were also poor decisions made a few years ago by the Scottish Government on the number of nursing students we train.

Then we have the rising drugs budgets, financial savings and growing numbers of patients.

We know there is really good work going on across the NHS. We know that staff are trying to do their very, very best for their patients in difficult circumstances.

But the report picks up on the fact that surveys show staff don’t feel they have enough resources to do what they really need to do. The vast majority of nurses go into the job wanting to give the best possible care to patients.

Pressure

No member of NHS staff wants to go home from work every day thinking they are under pressure because there aren’t enough of them on the ward. The report really brings this to life when it talks about vacancies going up and the increase in agency staff.

It warns of the difficulties facing many health boards trying to recruit and retain staff and says the greater use of temporary workers may ‘pose risks to patient safety and quality of care, from poor continuity of staff, temporary staff being unaware of local systems and processes or a lack of employees to provide safe care’.

So the report tells us what staff shortages mean for patients and their families and what they mean for a nurse who is trying to deliver care to someone who really needs it. It’s good for no one.

The fact is, whatever we do, the NHS is going to look different in the future.

If we do nothing, the quality of our health services will slowly decrease and that is not good for patients, families, the public or staff. None of us wants to see that happen.

So we need to plan for something that works better and not close our eyes to what’s happening and end up with services that look worse.

What we need is a really open, honest, frank discussion about what we want the NHS to be and how we make it work within the resources we have so that everyone gets the right care, at the right time, in the right place, according to their need.

The Scottish Government has put out a lot of reports and strategies, which quite rightly try to address how to balance resources and demand. We have a Scottish Government strategy that aims to set a direction of travel – such as patients being cared for ‘at home or in a homely setting’ and only going to A&E or being in hospital if or when they really need to be there.

But we need to understand when and how things will happen and how we are going to have the resources in the right place to make sure that health and social care services can work better together.

Currently, the Scottish Government has set a direction of travel, but has not said how we are going to get there or given the public any timescales on when this will happen. It’s also not clear how the Government will get the buy-in of the public and staff, to change how our health services are delivered and make sure they’re fit for the future.

We have an ageing population and this is a good news story because we are living longer.

But we are not always living in good health and more people are living with longterm health problems or illnesses, such as heart disease, diabetes, strokes and dementia.

This, however, needs a lot of input from health staff, both in hospitals and in the community – and this is likely to grow as our population gets older.

We need to move a lot faster on getting care out of hospitals into the community or in patients’ homes. But the fact is, as the Auditor General says, we have not yet seen this happening enough. People should only be in hospital if they really need to be there – and the vast majority of people would prefer to be looked after at home.

Skills

To make this happen, what we need is the right people with the right skills in the right place – making sure we have the mix of people right will mean that patients get a highquality health service, now and into the future.

There is a lot to do. I do not envy the NHS boards, who are between a rock and a hard place. We have called for some time for a much more flexible approach to how boards are allowed to manage their money, in order to let them make longterm decisions.

Audit Scotland makes a specific call for three-year rolling budgets instead of the current system of boards having to meet annual financial targets. Having to meet their budget targets in a one-year time frame means they can’t take a long-term view.

Only last week, the Royal College of Nursing warned of a ‘perfect storm’ with boards cutting their staff to balance their books. Now the Auditor General is raising concerns across the whole of the NHS.

There are ways we can make things better – and we already have some of the answers. One of these is for politicians of all parties and health professionals to put aside their own interests and work together to achieve the changes that are so desperately needed.

But the key question is: How do we move forward from here?

That is what the Scottish Government must focus on.