By Theresa Fyffe, director of RCN Scotland
As a light was briefly shone on the state of our NHS yesterday morning, with the Scottish Parliament’s health committee grilling a selection of health boards on their finances, now seems as good a time as any to take stock of NHS Scotland’s financial situation. While the noughties saw record increases in the NHS budget, the more recent past is not so positive and the future looks likely to be austere.
It seems churlish to complain about the NHS budget and there is no escaping the oft-repeated mantra that it has been “protected” by the Scottish Government while funding for local government, for instance, has been cut. However, the reality of the situation is that the budget for the NHS has been effectively flatlined, while both costs to the NHS and demand for health services are on the increase.
One of the reasons costs are going up is spiralling drug budgets, as confirmed at yesterday’s committee session. And, inevitably, demand for services is going up because of our ageing population and the fact people are living longer with more complex conditions – a welcome sign of advances in our health service, often working in partnership with social care, improving people’s health and quality of life. But the consequence of this is that our NHS is in a self-perpetuating cycle of financial pressure: it supports people with complex conditions to live longer and healthier lives, which in turn means demand on health services continues for longer.
So, instead of the “NHS budget is protected” soundbite coupled with health boards being told to carry on as usual, the future direction of our health service needs to be clearly set out. Otherwise cuts will continue, the workforce will become more and more overstretched and patient care will suffer. Since 2009, for example, almost 2,200 nursing and midwifery staff have been lost. And with nurses delivering the vast majority of care, this is bad news for patients and bad news for the overstretched nursing staff left behind.
When it’s been clear that proposed changes would be bad for patient care, we’ve challenged this tactic of heath boards making “easy” savings by cutting nursing and other posts to save money. While we recognise that change is needed and are willing to play our part, we’ve now reached a tipping point and chipping away at the workforce is unsustainable.
And with “efficiency savings” – made to provide the same or better services for less money – being the only way health boards can shift money about within their budgets to keep afloat, it is worrying that most now report meeting efficiency targets as one of their highest financial risks. Indeed, this time last year many health boards had set efficiency targets to be met by the end of the financial year but in many cases had not identified how these savings were going to be made. It is no wonder that such savings can often be cuts by another name.
So, what about when the time comes, surely due soon, when a health board proposes to close a hospital department and move services, such as rehabilitation for people with strokes or brain injuries, to the community? While shifting health services closer to people so they can be supported to live at home would be in line with the Scottish Government’s vision for the NHS, will it support health boards when they try to do this? Or will the closure of totemic local hospital departments or even entire hospitals be too much for politicians and the public to swallow?
With much of the NHS estate in desperate need of refurbishment or renewal this would seem a good time to change the way healthcare is delivered. But the Scottish Government’s 20:20 vision for the NHS to be interpreted locally by health boards, revealed last year without fanfare, is not going to give much support to boards when they start to seriously contemplate these difficult decisions.
Indeed, point-scoring over such decisions can be just too attractive to politicians of all parties, and the significance of such political interventions cannot be overstated. Just look at the political impact of the planned downgrading of Monklands and Ayr A&Es and the planned – and later delivered – changes to Stobhill Hospital services in 2007.
The true test of how committed the Scottish Government and opposition parties are to the future of the NHS will be their reaction to any future plans by health boards to redesign services to be delivered in the community, thus resulting in hospital closures. While we will scrutinise such decisions to ensure they will result in better patient care and not be about cutting bills, we expect politicians to do the same. And if the conclusion is, yes, this plan will improve things, then politicians must respond with maturity rather than a knee-jerk reaction focused on winning votes at the next election.
So, let’s end this impasse on the state of Scotland’s NHS – it shouldn’t be a matter of claim and counter-claim about whether its budget is protected. The public and the overstretched staff of the NHS deserve better. Health boards need clear parameters in which to operate. This will allow them to make the difficult decisions, which are becoming urgently needed, to balance the books – and provide top-class health care for Scotland’s communities. It’s time to shine that light very brightly on those making the decisions about our NHS.