Dr Brian Keighley: It’s time to decide what kind of NHS we can afford

We all understand the impact a tough financial climate is having on the NHS, and while there is no doubt that the NHS must try to be as efficient as it can, it is widely accepted that efficiency savings alone will not be enough to cover the funding gap produced by healthcare cost inflation. It is clear that a number of difficult decisions will have to be made.

The intense pressure to make savings means boards will find it harder to achieve their targets each year. Consideration may be given to cutting frontline services and to making indiscriminate cuts that are not only short sighted but could cause irreparable long-term damage to the NHS.

This is why it is vital that politicians and managers avoid knee-jerk reactions to falling budgets and avoid making hurried changes to achieve savings. Plans so far have included cutting nursing staff numbers, imposing a recruitment freeze and attempts to undermine the terms and conditions of NHS employees.

While these may deliver a quick reduction in financial spending, they are not long-term answers. Consideration must be given to the impact of these decisions on patient care. Evidence must be gathered and proper processes put in place to involve clinicians, patients and local populations in any decision-making
process.

One area that could be looked at is how NHS services are configured across Scotland, in particular within secondary care, ie: hospitals. Any reconfiguration proposals must be focused on maintaining or improving patient safety, clinical results and the quality of care received by patients.

To succeed, reconfiguration must be based on sound clinical grounds and must include hospital closures or downgrading. Difficult decisions will have to be made but ultimately it should be about patient safety and maintaining service viability and not political expediency. With current plans to reform adult health and social care integration, initiatives to move services from being provided within hospitals out to the community will mean a careful re-examination of where NHS money is being invested.

Last week, Audit Scotland published its report on the financial performance of the NHS from 2011-12. The report highlighted the need for long-term financial planning and for the Scottish Government to help boards invest in new ways of working to help that happen more effectively.

Over a long period, the British Medical Association (BMA) has called for the Scottish Government and NHS boards to work with the healthcare professions to identify how services can be made more efficient without compromising patient safety or quality of care. Doctors are at the heart of the health service, they are therefore best placed to provide strong clinical leadership and to identify waste and inefficiency. Doctors want to be, and should be, a part of any solution.

The BMA remains committed to a comprehensive NHS that is publicly funded, publicly provided and is free at the point of delivery. These principles remain as true today as they did in 1948. The range and level of services that are available today are more comprehensive and complex, and patients’ expectations are higher. To protect the principle of universal free healthcare, politicians must lead the open and honest debate with the public about what the NHS can and cannot afford. NHS boards must effectively prioritise services, rather than resorting to across-the-board cuts, even if this means making difficult decisions. At the heart of these decisions, however, should always be clinical need and patient safety.

If indeed clinical need and patient safety are the drivers for change in the NHS, as advocated by the BMA, rather than short-term financial pressures, sensible and thoughtful planning can only be ensured if governments and health boards work in partnership with doctors and other healthcare
professionals.

• Dr Brian Keighley is chairman of the BMA in Scotland

Increasing pressure

NHS Lothian is currently facing increased financial pressure on a number of fronts.

They are still trying to deal with a waiting list backlog that has seen patients waiting longer than the target of 12 weeks given the option of going to other hospitals in Scotland, at the expense of the local board. And it was revealed in yesterday’s Evening News that bosses are now looking at sending patients to private hospital in Europe to ensure they meet government targets.

In July the board revealed it had overspent its budget by £1.6 million in the first three months of the financial year, leading to fears that more jobs could be cut, and concerns have been raised about the levels of stress being faced by staff, with reports that many workers are putting in more than 72 hours a week.

This has also highlighted an underlying problem with the capacity at NHS Lothian, which new chief executive Tim Davison has admitted needs to be improved.

More staff are being recruited and a £2m investment in internal capacity was approved earlier this year.