As the debate around Scotland’s future moves into the final six months of its long campaign timeline, other issues are being drowned out by the noise of the constitutional drum-banging.

But one issue that will not go away is the future of the NHS in Scotland.

In Scotland there is a cross-party consensus that the NHS in Scotland will not go down the privatisation route being imposed by the Westminster coalition government. Even the Tories in Scotland accept that. But this does not mean that all is well in the NHS north of the border.

The reality is that the NHS in Scotland is under pressure like never before with budget pressures leading to auditor-general of Scotland Caroline Gardiner putting the NHS on an amber warning.

We see fewer staff – 1,000 nurses lost since 2009 – being asked to do more for less with increased work pressures at a time of pay cuts and increasing pension contributions. The use of the private sector and bank and agency staff are all significantly up – evidence of a system under huge pressure.

Social care is being driven down to the lowest common denominator with falling standards, reduced training and poverty pay – all of this resulting in bed-blocking and waiting times increasing. In Glasgow 20% of care home places are out of commission because of concerns over standards (15% in Edinburgh and Highland).

Across the NHS cases of bullying and the use of gagging clauses to silence staff is up, junior doctors are being left to look after up to 100 beds and working up to 100 hours a week while stories emerge of patients left on trollies and sometimes being treated in cupboards.

And all the time Scotland’s shame – health inequality – is increasing, unsurprising given the £1 billion of cuts to anti-poverty initiatives made by the SNP government.

In the summer I called for a full-scale review of the NHS in Scotland. This call followed wide-ranging discussions I have had with support staff, doctors, consultants, nurses, patients, trade unions and a range of stakeholders from across the NHS. The evidence they presented convinced me that we need to look at the whole system to ensure that the NHS in Scotland is fit to meet the needs and demands of the 21st century.

We need such a review to examine how we sustainably finance and resource the NHS, how we ensure that we have the right people in the right places and the right time to meet the growing demands and expectations on health services and we how we address the opportunities and challenges of an ageing population and the advances in personalised medicine and treatments. This weekend the Patients Association in Scotland joined the growing band of organisations and health professionals who have now supported the call for a review.
We need to start a national debate about the future of the NHS in Scotland and how we equip our greatest public service to meet the needs of the 21st century. Sticking our heads in the sands is a betrayal of our greatest public service.

This article first appeared in Healthier Scotland – The Journal Published by Socialist Health Association Scotland March 2014

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