I AM deeply disappointed in the lack of any concrete proposals to address the fundamental problems of our health services in this election campaign. We are sleepwalking to disaster under the delusion that the English NHS has problems whilst all is well within Scotland. England’s problems are well publicised and acute but they have begun to recognise that until primary care is properly resourced, the dustbin of the NHS, accident and emergency departments will buckle under massive inappropriate usage encouraged by media obsession with A&E waiting time percentage league tables. What the media (especially the BBC) should be asking is why are people attending A&E in such numbers - during the strikes in England there has been no problem as non-urgents have held back.
Money per se is not the problem; It is how it is targeted. After nine years in power the SNP which I have supported) has reduced the primary care pot of the total NHS budget to just over seven per cent of the total NHS budget- the lowest in NHS History.
It is harder to get GP appointments, bureaucracy and micromanagement have increased, A&E departments are filling up, hospital beds are under pressure as delayed discharges occur due to pressure on social services, district nursing services and carers – the mainstay of community care and the least valued and poorest paid. Raasay has lost its permanent nurse, as has Lismore – both of which islands supported district nursing by local subscription before the NHS. Recruitment in general practice especially in rural areas and rural hospitals (Wick, Fort William, Oban, the Western Isles) is in crisis. Suitable rural candidates are excluded because of an urban academic exclusivity to medical school admissions.
Following the American model of expensive, glossy hospitals such as the new Queen Elizabeth Southern General, which cost as much as the total primary care budget for the whole of Scotland, will only exacerbate the pressures on the NHS budget as administration, maintenance, renewals and so on devour ever more funds.
The solution? Negotiate a Scottish contract for primary care rather than perpetuating the Suburban UK 2004 contract. Provide funding to increase primary care staffing including district nursing, general practice, physiotherapy, psychiatric and psychological services as well as pharmacy, ophthalmic, audiology, speech and occupational health services. In return primary care should return its front line responsibility to 8am to 10pm Monday to Friday and Saturday mornings, which is not onerous when there is sufficient manpower to cover reasonable rotas.
Middle management must be vastly reduced. Individual professionals should be given more autonomy to deliver quality care rather than tick-box care.
This will lead to better access, more job satisfaction, less pressure on the ambulance service (the unsung mainstay of the NHS) and on hospitals. More people would be safely and caringly managed at home and we would be on track again for the world-class health service that we all strive for and could afford.
If any party endorsed these principles they would get my vote on Thursday.
Dr Iain McNicol (retired GP),
Dunvegan, Port Appin, Argyll.
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