Much of the romanticism that attaches to the NHS flows from its founding principle of providing medical services ‘free at the point of need’. In the wake of the grief and sacrifice of war, the health service represented another great coming together in a peacetime endeavour for fairness and decency.
A less lofty but more pivotal phrase is this: ‘[A] comprehensive health service designed to secure improvement in the physical and mental health of the people of Scotland and the prevention, diagnosis and treatment of illness.’ These, the opening words of the NHS (Scotland) Act 1947, are not quite as stirring but they are the operative description of the health service.
While removing the burden of insurance fees and charges was a central virtue for Minister for Health Aneurin Bevan, what set the NHS apart was its scale and comprehensiveness. It would meet all needs for all people in all times. That is why the Act made ministers responsible for ‘the effective provision of services’.
One of the necessary fictions of the past seven months has been that of a plucky NHS plugging on in spite of everything. In the words of Health Secretary Jeane Freeman: ‘Throughout the pandemic NHS Scotland has remained open, delivering emergency services and vital care.’ We all know this is not true. Since March, the NHS has not been comprehensive. It has not been improving physical and mental health. It has not been preventing, diagnosing and treating illness to the same extent.
A significant part of the health service was placed in a temporary coma to accommodate the response to Covid-19. While a global pandemic was always going to disrupt its operation, the degree to which basic NHS functions have been suspended is far-reaching and unprecedented. Everyone will have their own story, from personal experience or that of a friend or loved one. The cancelled surgery, the extended stay on a waiting list, the bureaucratic assault course that lies between picking up the phone and seeing a GP.
The statistics confirm just how common these occurrences are. There were almost 16,000 fewer planned operations in July 2020 (the most recent month for which figures are available) than for the previous July. Nearly 65 per cent of patients waited longer than the six-week target for a key test result and half for longer than 13 weeks. The backlog meant 7,500 extra patients waiting for an endoscopy and 2,500 more for a radiology test than this time last year.
The target for 95 per cent of new outpatients to be seen within 12 weeks of referral has simply ceased to exist. By the summer, those seen under this standard had plummeted 66 per cent on summer 2019. The same goes for the Treatment Time Guarantee, which says that all eligible inpatients should be seen within 12 weeks of a decision to treat. In fact, the number of patients being treated under this guarantee plunged 79 per cent on last year.
We get daily updates on coronavirus but not on the human toll of making coronavirus our only priority. That cost includes a 64 per cent drop in referrals to IVF treatment, an 80 per cent decrease in chronic pain sufferers seen and a fall of more than half in children and young people referred to mental health services. This is no one’s idea of ‘the effective provision of services’.
Eventually, waiting times will return to normal, which, in most cases, means targets still being missed but by less. However, the anguish caused by these months of disruption cannot not be undone. When these people needed the NHS most, it closed its doors to them.
The resumption of services is under way, albeit gradually. Breast cancer screening has restarted and there is a plan to ‘remobilise and redesign’ cancer care. Community optometrists are handling patients with long-term and sight-threatening conditions whom hospitals could not help under their emergency measures. Dentists are at last seeing people left in pain for months, though access to dental services remains a more complicated picture than high registration rates would suggest. Slowly, the NHS is being brought back round.
That process must be accelerated, especially as we head into winter, where the double whammy of Covid-19 and flu could bring the health service grinding to a halt once again. The signs are already coming into view. An additional 800,000 people are eligible for the flu vaccine this year because of coronavirus and the rush has so far caught NHS bosses off-guard.
NHS Fife told older patients to stop calling its flu jab hotline because its eight call handlers could not deal with the 1,000 calls coming in every hour. To her credit, chairwoman Tricia Marwick apologised swiftly, admitted the health board ‘had not prepared adequately’ and drafted in more telephonists. Better than expressions of regret is proactivity to make sure these scenes are not repeated in other health boards.
The logistics of delivering the vaccine also need to be looked at. MSPs are hearing from constituents who ought to be getting the injection but have no car to drive to the centralised locations where it is being offered. They face the choice of making multiple journeys on busy public transport or going without the jab. It is vital that these problems are remedied promptly for flu and factored into the planning for any coronavirus vaccine.
To find its footing again, the NHS must recall the terms on which it was established. It exists to secure improvement in the physical and mental health of the people of Scotland, not some of the people of Scotland, some of the time and for some conditions but not others. Unless the health service returns expeditiously to its original purpose, the purpose which has earned it the respect and affection of generations, its fitness for the task assigned it may start to come into question. This is particularly the case for priority conditions such as cancers, heart disease and strokes, but for many other illnesses too.
An NHS free at the point of need is only as good as its availability at the point of need. An NHS that yanks down the shutters when times get tough is one failing to live up to its founding spirit, which is a spirit of service. These are, we hope, extraordinary times and treating Covid-19 will naturally be at the forefront of what the NHS does, but it can no longer be all or most of what it does. The NHS belongs to us, not to ministers or managers, and we must insist that it reopens to us — now.
Finally someone said it. Douglas Ross’s conference speech was a long overdue rebuke to self-indulgent Tories down south, who have either stopped caring about the Union or simply lost their nerve for the struggle against separatism.
The Scottish Conservative leader told virtual delegates that these faint-hearts were not only complacent but complicit; ‘doing the SNP’s work for them’ in his bracing words. More incendiary still was his declaration that: ‘The case for separation is now being made more effectively in London than it ever could in Edinburgh.’
Ross didn’t just issue his southern colleagues a wake-up call. He lamped them around the head with the alarm clock. Speeches are important but actions count more and now we must see the UK Government stepping up and defending the Union politically and legislatively. Law-breaking capers aside, the Internal Market Bill is a good start but nothing more. Douglas Ross has shown he has the right idea. The Prime Minister must show he has the right plan.
Aberdeen is marking a political milestone: the 150th anniversary of The Grill. The Union Street pub has been serving thirsty Dons since 1870 but it is also the preferred watering hole for MPs and journalists during party conferences in the Granite City. How many scoops must have begun life over a pint in this venerable establishment. May it see another 150 years.