Shona Robison, the health secretary, has ordered a review of NHS staffing levels over the Christmas and New Year period so that patients may receive “better” care at the busiest time of the year than has been the case in recent weeks. Ms Robison’s announcement is welcome even though, like the Christmas season itself, the annual NHS “winter crisis” seems to begin earlier every year.
In any case, although eminently predictable, this winter’s struggles are hardly exceptional. These pressures, as everyone knows, will only get worse. The ageing profile of Scotland’s population ensures that the difficulties the NHS faces this year are less pressing than those it will face next year and, in the absence of significant changes, every subsequent year. This demands a measure of frankness: ministers know the status quo cannot endure much longer and health professionals know this too. But voters do not.
Instead, arguments over health policy are reduced to whether arbitrary targets, such as the requirement that patients attending accident and emergency services be seen within four hours, have been met. At no point are the merits of those targets discussed, far less whether being seen by a specialist within three months should be considered the mark of a world-class health service. Instead success, or failure, is determined by what can be measured, not by the standard of care received by patients.
As Andrew Robertson, former chairman of the NHS Greater Glasgow and Clyde health board, told this newspaper last week: “The sense that all of us have about the NHS is that it’s being run on a wing and a prayer.” That might be just enough to get through a seasonal crisis; it cannot be thought good enough for a public service upon which, almost uniquely, almost everyone relies.
Change must come, so the question for ministers is whether they lead that reform or, instead, react to external pressures forced upon them by demographic and technological change. One thing is clear: since every part of the service — from a lack of capacity in hospitals to a shortage of general practitioners — faces severe and worsening pressure, simply tinkering with the NHS will not be enough to equip it for the challenges it will face in the future.
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That means much more wide-ranging reform is needed. For that to be the case, politicians from all parties will have to be honest with voters instead of pandering to their worst instincts. In some instances, for example, local services that cannot be provided efficiently may have to be transferred to larger, specialist units. Similarly, reducing the number of health boards could eliminate unnecessary, and expensive, duplication of resources.
Closing unproductive units guarantees adverse publicity but, far from undermining the health service, such rationalisation may help to save it. That in turn opens a path to more honest discussions about the level of funding the NHS should receive and where that money would most usefully be spent. The alternative is further bodges designed to shore up a Heath Robinson contraption of such complexity that no one can quite remember how it actually is supposed to work.
If the National Health Service is to stay the same, much will have to change. But that requires bolder and more honest politicians, as well as ones who are not taken by surprise by the arrival of winter each year.