Last year at this time, Scotland’s Unionist media and politicians were all gleefully predicting a crisis in health care as Scotland’s hospitals failed to meet, they hoped, with the increased winter demand. Here are just two of the stories from the Daily Record and the Daily Express:
Reporting Scotland ran happily with these stories in December and early January, as I remember, but then realised there hadn’t been any crisis in Scotland despite what the Red Cross described as a ‘humanitarian crisis’ in NHS England. See:
On the 12th January 2017, they seemed to realise the ba’ was on the slates and backed off if a little grudgingly with a report in which more than one phrase recognised the superior performance of NHS Scotland. It was of course a bit quiet and qualified with more than a few ‘buts’, but, nevertheless it was an absolute shock for those of us who have been monitoring them since before 2014. Read and be amazed that they said:
‘We’ve heard a lot in the last few days about the NHS crisis (emphasised) in England. I think it would be fair to say the picture in Scotland looks better…’
If we look at the figures for A&E, the figures show we’re better off, as the First Minister said, we’re 10% better off…’
‘In terms of social care, we are doing some good work on the ground….’
‘We’re maybe (!) not using the term ‘humanitarian crisis to describe the state of the NHS in Scotland….’
Now, I know all the above were followed by a ‘but’, but what followed was never a piece of evidence to cast serious doubt on the preceding good news. Mostly it was a vague comment about vague, unquantified, future challenges or the failure to meet the Scottish government’s own very high targets.
Now what’s happening this year. Are they scared this time round to predict a crisis in NHS Scotland? I searched thoroughly and could find nothing at all really predicting that NHS Scotland would struggle this winter. All my search threw up was this:
‘Will extra cash be enough to stave off a winter crisis in the NHS in Scotland? Scottish Health Secretary Shona Robison has announced an additional £5m to support winter planning across the NHS in Scotland. Although she said the Scottish NHS was well placed for winter, Ms Robison conceded that there was no room for complacency, and that the new money would give health boards and their partners an extra boost. The money is in addition to funds already allocated to tackling waiting times for treatment and A&E waits. Some of it will be used to pay for additional staff to allow more patients to be discharged at weekends.’
You’ll see the headline’s question is not tackled at all in the short text. Wonder why? No evidence perhaps?
Moving to NHS England and Winter 2017/18, the media picture is quite different. A search throws up numerous scare stories predicting another crisis this year. Here are only five from many more:
You’ll see in my previous post the threat to drop targets as one way of hiding any crisis. Perhaps worse, the astonishing idea of banning patients from going to A&E without prior permission has been floated:
So, you feel you might die, make an appointment with your GP, s/he sends an email authorising your visit, but you don’t make it?
Why did NHS Scotland cope so much better than NHS England last winter? It wasn’t higher spending. Here’s a reminder of the main reasons identified by the Nuffield Trust:
Scotland has a unique system of improving the quality of health care. It
focuses on engaging the altruistic professional motivations of frontline staff
to do better, and building their skills to improve. Success is defined based
on specific measurements of safety and effectiveness that make sense
Scotland’s smaller size as a country supports a more personalised, less
formal approach than in England. The Scottish NHS has also benefited
from a continuous focus on quality improvement over many years. It uses
a consistent, coherent method where better ways of working are tested on
a small scale, quickly changed, and then rolled out. Unlike in the rest of the
UK, this is overseen by a single organisation that both monitors the quality
of care and also helps staff to improve it.
Scotland faces particular issues of unequal health outcomes, and very
remote areas. There are pioneering initiatives to address these, like the
Links worker programme and Early Years Collaborative to support
people in very deprived areas, and use of video links for outpatient care on
remote islands. These should be considered in other parts of the UK facing
There is much for the other countries of the UK to learn from this. While
comparing performance is very difficult, Scotland has had particular
success in some priority areas like reducing the numbers of stillbirths.
Scotland’s system provides possible alternatives for an English system
with a tendency towards too many short-term, top-down initiatives that
often fail to reach the front line. It also provides one possible model for
a Northern Irish NHS yet to have a pervasive commitment to quality
improvement, and a Welsh system described as needing better ways to
hold health boards to account while supporting them in improving care.
Scotland has a longer history of drives towards making different parts of
the health and social care system work together. It has used legislation
to get these efforts underway while recognising that ultimately local
relationships are the deciding factor. There is much for England and Wales
to learn from this.
Research Report, July 2017, Learning from Scotland’s NHS at: https://www.nuffieldtrust.org.uk/files/2017-07/learning-from-scotland-s-nhs-final.pdf