\n It\u2019s rather fitting, given that Kennedy \u2013 chair of the British Medical Association (BMA) in Scotland \u2013 believes the health service is \u201cdying before our eyes\u201d.\n<\/p>\n
\n Kennedy met with The Herald on Sunday to dissect the NHS. He put the health service on the anatomy table, opened it up, and his prognosis is that \u201cthe system is broken\u201d.\n<\/p>\n
\n Patients \u201care dying\u201d unnecessarily because of delays. Doctors feel no \u201cpride\u201d any more in the service they provide, there\u2019s a \u201ctoxic culture\u201d of cover-up, and a collapse in public confidence is \u201ccausing people to question the future of the country\u201d.\n<\/p>\n
\n Scotland lacks \u201cat least 1,000 GPs\u201d and 1,000 hospital consultants. Patients can wait \u201ctwo, three or even four weeks\u201d to see their GP. Waiting times for \u201clife-threatening\u201d cancers can be \u201csix weeks\u201d.\n<\/p>\n
\n It\u2019s a far cry from the foundation of the NHS, Kennedy explains, inspired by early experiments in social medicine in Scotland\u2019s highlands. In 1913, the Highland and Islands Medical Service became \u201cthe first state-funded health service\u201d.\n<\/p>\n
\n In 1948, the Labour government replicated the Scottish experiment UK-wide. \u201cWhen the NHS started, there was a strong sense of pride, unity and vocation. It met the needs and demands of the population. That\u2019s the key thing that\u2019s changed: we no longer meet the needs and demands of the population.\n<\/p>\n
\n \u201cIt was largely doctor led. People had a lot of trust and confidence. It gave a strong sense of security to the public. It was one of the UK\u2019s finest moments and probably the institution we should be most proud of.\u201d\n<\/p>\n
\n While political decision-making and funding is to blame for the state of the NHS today, demographic change and \u2013 ironically \u2013 medical advancements have also affected the health service.\n<\/p>\n
\n \u201cDemand is so great as the population has grown,\u201d says Kennedy. \u201cThe population is older, and more complex.\u201d\n<\/p>\n
\n Kennedy started studying medicine in 1987.\n<\/p>\n
\n When he was a junior doctor, \u201cpeople would come to hospital with strokes, heart attacks and pneumonia and they\u2019d die young \u2013 in their late thirties, forties or fifties. I don\u2019t see those illnesses in young people like I once did.\n<\/p>\n
\n \u201cNow we have patients who are older, frailer and survive these illness, and live with five, six or seven long-term conditions.\u201d\n<\/p>\n
\n These \u201chighly complex\u201d cases often involve people who \u201cdon\u2019t have the same social fabric around them\u201d for support as elderly people once did. \u201cThey\u2019re more reliant on the health service and social care.\u201d\n<\/p>\n
\n Dr Iain Kennedy chairs the British Medical Association Scotland(Image: )\n<\/p>\n
\n However, he adds: \u201cWhat\u2019s clear is that we simply aren\u2019t meeting the needs of the people of Scotland any more. We\u2019re certainly not meeting demand.\n<\/p>\n
\n \u201cI don\u2019t think there are many doctors \u2013 and there are 17,000 of my members in Scotland \u2013 who will say they\u2019re proud of the NHS overall. That sense of pride has gone. Doctors don\u2019t feel in control any more. The NHS is managerially led, rather than doctor led.\n<\/p>\n
\n \u201cIt\u2019s become politicised. It\u2019s a political football now. Our patients are frustrated, angry and struggling to get GP appointments. They\u2019re waiting longer and longer for outpatient appointments.\u201d\n<\/p>\n
\n Dysfunction\n<\/p>\n
\n WHEN patients are able to access care, however, they \u201cinvariably tell us they get excellent care. So if they access GP appointments, hospital outpatient appointments, hospital inpatient beds, the stories are extremely positive \u2013 but it\u2019s accessing healthcare that\u2019s difficult\u201d.\n<\/p>\n
\n A key dysfunction is that \u201cfar too many people stay in hospital for far too long when they no longer require hospital beds\u201d. Kennedy explains the \u201clack of social care\u201d means the \u201cback door to the hospital is closed\u201d. Elderly patients, in particular, who could go home, can\u2019t go home as there\u2019s nobody to provide social care on release.\n<\/p>\n
\n \u201cThe system is clogged up,\u201d Kennedy adds. \u201cGPs are backed up. Patients are coming back and back to see GPs who are chasing up [hospital] appointments that don\u2019t seem to be happening.\u201d\n<\/p>\n
\n Patients \u201cfrustrated\u201d with being unable to see their GP eventually go to A&E, which in turn leads to hospital overcrowding. The lack of beds \u2013 due to elderly patients who can\u2019t be released as there is no social care \u2013 means doctors \u201ccan\u2019t transfer patients out of A&E\u201d into other wards.\n<\/p>\n
\n Doctors now report \u201cthat they\u2019ve relearned how to do ward rounds in emergency departments because patients are staying two or three days. That\u2019s why we see headlines about long A&E waiting times and \u2018corridor care\u2019 because the hospitals are clogged up with people who\u2019d rather be back home or in care homes\u201d.\n<\/p>\n
\n Kennedy adds: \u201cTo be frank, the system is broken. The NHS in Scotland is dying before our eyes. We\u2019ve lost the founding principle of the NHS \u2013 that it\u2019s free at the point of delivery – as many people are having to go private and they\u2019re not happy about that.\u201d\n<\/p>\n
\n READ MORE\n<\/p>\n
\n Neil Mackay: English nationalism will be the death of the union<\/a>\n<\/p>\n \n THE BIG READ: Professor Sir Geoff Palmer: \u2018My family were owned as slaves by Scots. It\u2019s time this nation faced up to its history\u2019<\/a>\n<\/p>\n \n Neil Mackay: Humiliate them. Ruin them. Stamp on feral Old Firm ultras, hard<\/a>\n<\/p>\n \n Neil Mackay: How Scotland\u2019s disabled folk changed my view on assisted dying<\/a>\n<\/p>\n \n One-third of Scots, or someone in their household, has gone private in the previous two years, Kennedy says, and 40% are considering doing so in the year ahead. \u201cIt\u2019s become commonplace. My patients tell me \u2018I went private for my knee operation, my hip operation, my scan, because I just couldn\u2019t wait any longer on the NHS\u2019. People are angry.\u201d\n<\/p>\n \n One of Kennedy\u2019s patients recently told him how \u201cangry and frustrated\u201d he was at \u201cpaying taxes all his life and then having to fork out\u201d for two operations.\n<\/p>\n \n \u201cPeople are going private as they\u2019re distressed with pain,\u201d Kennedy adds. \u201cThey\u2019ve lost confidence that the NHS will attend to them, so they\u2019re reluctantly dipping into their pockets or using their insurance to go private.\u201d\n<\/p>\n \n Toxic\n<\/p>\n \n A \u201cTOXIC culture\u201d exists within the NHS in Scotland and throughout the UK. \u201cWhen doctors speak up about matters of patient safety or issues of wrongdoing that they\u2019re witnessing, invariably they experience retribution and retaliation.\u201d\n<\/p>\n \n A majority of doctors has \u201cexperienced concerns about patient safety or wrongdoing, but only 17% were satisfied with the outcome\u201d.\n<\/p>\n \n Kennedy adds: \u201cWe have something seriously wrong with NHS culture. Doctors tell me they experience bullying from managers, and their mental health is questioned.\u201d\n<\/p>\n \n Doctors who complain \u201cfear referral\u201d to the General Medical Council which could lead to being struck off and \u201cjob loss. There\u2019s a culture of fear. Young doctors and non-white doctors are particularly frightened about speaking up because of retribution and retaliation\u201d. An example of the complaints doctors might make about patient safety would be, says Kennedy, \u201cpatients dying in A&E departments before they\u2019re seen. That\u2019s a fairly basic one. Another example is doctors who raise concerns about waiting times for their patients, or referrals to hospitals being rejected\u201d.\n<\/p>\n \n \n Doctors are \u201cexperiencing more and more that when they refer patients to outpatients the referrals are rejected\u201d. In Kennedy\u2019s own patch, in the Highlands, \u201c46% of the referrals from GPs to the mental health service are sent back\u201d. Doctors who raise concerns \u201cget sidelined, marginalised and not listened to. The system doesn\u2019t want to hear about the problems\u201d.\n<\/p>\n \n Scottish health boards, he believes, \u201cfocus on reputational management. That\u2019s the fundamental problem. Their prime aim is to manage the reputation of the organisation rather than focus on patient safety. They pay lip service to patient safety. The health board\u2019s reputation comes first\u201d.\n<\/p>\n \n Kennedy puts this down to the \u201cpoliticisation\u201d of the NHS. \u201cThere\u2019s a culture of \u2018boss-watching\u2019. Each individual in the structure looks up. There\u2019s a line from the clinicians to middle management, to the executive team, to the chief executive, to the director-general of the NHS in Scotland, to the civil servants, to the Cabinet Secretary for Health, up to the First Minister<\/a>.\n<\/p>\n \n \u201cThere\u2019s an axis of power that goes all the way up to the most senior people in the country. That\u2019s why we have this culture problem.\u201d\n<\/p>\n \n Kennedy does, though, stress that the current Health Secretary Neil Gray<\/a> \u201chas assured me that patient safety is something health boards must prioritise\u201d.\n<\/p>\n \n Does he believe that a deteriorating NHS, coupled with a culture of reputational management, risks issues of public interest being coveredup? \u201cThat hits the nail on the head,\u201d Kennedy says. \u201cHealth boards generally want to hide problems. Problems tend to be brushed under the carpet.\u201d\n<\/p>\n \n Cover-up\n<\/p>\n \n HE has \u201cpersonal experience\u201d of health boards wanting to avoid \u201cnegative media stories about anything going wrong in the health board, or any bad reports going back to government. Those were their priorities\u201d.\n<\/p>\n \n He adds that \u201cin terms of \u201ccover-up\u201d, if you use the word cover-up\u201d, he had experience of one health board refusing to \u201cshare waiting times\u201d with doctors. \u201cWe knew as clinicians that waiting times were getting worse and worse, and they wouldn\u2019t share them, on the basis that other health boards weren\u2019t sharing that information. That\u2019s how bad it was. They were hiding the truth.\u201d\n<\/p>\n \n What\u2019s actually going on when it comes to accessing GP appointments? Kennedy says patients in rural practices will \u201cgenerally\u201d still get \u201csame-day appointments\u201d as there\u2019s \u201cless demand\u201d. But in urban practices \u201cdemand is our main problem\u201d.\n<\/p>\n \n Kennedy, who still works as a GP, runs practices in both rural and urban areas. In his urban practice, receptionists and nursing staff \u201ctriage\u201d calls to decide when patients can be seen. \u201cWe can\u2019t simply see everyone who wants an appointment. We\u2019d grind to a halt within an hour.\u201d\n<\/p>\n \n That means \u201cthere are people waiting far too long to see GPs. Some of my patients are maybe waiting two, three, even four weeks to see the doctor of their choice. Ultimately, it comes down to funding\u201d.\n<\/p>\n \n The BMA \u201cis asking for funding restoration for GP practices in Scotland. We\u2019re \u00a3290 million short of funding for general practice in Scotland\u201d. Over recent decades, \u201cthe number of GPs has flatlined. So the real reason people struggle to see their GP is lack of funding in general practice. That needs sorted urgently\u201d.\n<\/p>\n \n \n Ironically, there are \u201cquite a number of under-employed and even unemployed GPs in Scotland who could come into the workforce. Most of us would take on more GPs if we had the resources\u201d.\n<\/p>\n \n If more money was spent on GPs, it would mean fewer patients requiring more expensive hospital care. \u201cWe\u2019re at a critical juncture in the NHS,\u201d says Kennedy. \u201cWe need to shift the balance of care \u2013 that\u2019s the phrase we use for focusing resources in the community rather than in hospitals.\u201d\n<\/p>\n \n He stresses that doesn\u2019t mean taking funds from hospitals, which need their resources \u201cprotected\u201d. It means additional funding for GPs. The Scottish Government<\/a>, he notes, has \u201cspoken about shifting the balance of care for almost 20 years, but they\u2019ve done the exact opposite. Most resources have gone into hospitals, and general practice has been starved. We\u2019re reaping the consequences\u201d.\n<\/p>\n \n There is no \u201cproper workforce plan in Scotland for doctors and other healthcare workers. We\u2019ve been calling out for that for at least three years\u201d. A workforce plan would \u201cassess the health needs of the population, and work out the numbers of doctors you need and in which specialties. There are almost 15% consultant vacancies in Scotland. We\u2019re probably 1,000 consultants short.\n<\/p>\n \n \u201cWe\u2019re many GPs short. We\u2019ve practices falling over throughout Scotland, particularly in deprived and rural areas. We\u2019re at least 1,000 GPs short.\u201d\n<\/p>\n \n While the number of medical students has increased, \u201cwe didn\u2019t increase the capacity of our medical schools and teaching hospitals to cope with rising numbers of students. So students are reporting really poor educational experiences. They can\u2019t even get into the lecture theatres. When they\u2019re getting taught on wards there\u2019s too many for the teaching doctors to cope with\u201d.\n<\/p>\n \n Bottleneck\n<\/p>\n \n IN addition, resident doctors \u2013 formerly junior doctors \u2013 \u201care experiencing a real bottleneck. They come to the time in their career where they\u2019re choosing their speciality and there\u2019s not enough training positions for them\u201d.\n<\/p>\n \n Kennedy adds: \u201cSo we actually have in the UK and Scotland a situation right now where we have doctor unemployment, as we have all those vacancies.\u201d Around 70% of resident doctors are concerned about unemployment.\n<\/p>\n \n He says Scotland needs to change how we \u201cmeasure the NHS\u201d. He wants a system which focuses on \u201cthe quality of patient care, the outcome of care, and their access to care\u201d.\n<\/p>\n \n He adds: \u201cAs a country, we\u2019ve taken our eye off the ball. There\u2019s been a lack of accountability. There\u2019s been too much siloed thinking, rather than fundamentally looking at the health needs of the population. It\u2019s such a basic thing to do \u2013 to look at the health needs that are actually there, and then plan your service accordingly. We just haven\u2019t done that. We\u2019ve sleepwalked into this situation.\u201d\n<\/p>\n \n Kennedy says the waiting time crisis in A&E departments \u201cis simply the sign of a bigger problem. It\u2019s the flashing light for the fact the whole NHS system is broken\u201d. More than 800 deaths in Scotland were linked to long A&E waits last year.\n<\/p>\n \n He adds the deaths were \u201cassociated with long A&E waits before admission\u201d and were \u201cextremely concerning, but sadly not surprising. It\u2019s a tragic but entirely predictable outcome of a system in crisis\u201d.\n<\/p>\n \n The problems at the \u201cfront door and back door of hospitals\u201d \u2013 accessing GP appointments, and delayed discharge from wards due to lack of social care \u2013 \u201care manifesting themselves in the fact that we have long waits in A&E. So piling more resources into A&E is never going to be the solution\u201d.\n<\/p>\n \n He adds: \u201cThe problems my members report in A&E departments is that patients are dying before they\u2019re seen, and they\u2019re lying in trolleys and corridors. That\u2019s not a nice place to spend a day or two struggling to get your basic personal care looked after.\n<\/p>\n \n \u201cThere\u2019s a lot of moral injury and distress, where doctors feel very frustrated and guilty about the service they\u2019re providing for patients. We\u2019ve invested more and more in A&E but we can\u2019t continue doing that because it\u2019s just a sticking plaster.\u201d\n<\/p>\n \n Are patients dying unnecessarily? \u201cYes. What my members tell me is that patients would have survived had they been seen sooner. We know that there\u2019s evidence of what we call \u2018excess mortality\u2019. The figures show that more patients are dying than should have died because they\u2019ve waited too long. That\u2019s the harsh reality of the current situation. It\u2019s obviously a huge worry and why we need urgency around reform and renewal of the NHS in Scotland.\u201d\n<\/p>\n \n Patients can wait \u201ctwo or three days\u201d in A&E. That doesn\u2019t mean, Kennedy explains, that they\u2019re waiting to be seen for two or three days, but rather they\u2019re forced to remain in A&E \u201cbecause they can\u2019t get hospital beds\u201d.\n<\/p>\n \n Renewal\n<\/p>\n \n THE BMA called for a \u201cnational conversation on the NHS in Scotland\u201d. However, \u201cthe government chose not to do that. They\u2019ve moved forward with plans for \u2018renewal\u2019. We really need those plans put into action urgently\u201d.\n<\/p>\n \n Kennedy says patients able to access the NHS get \u201cexcellent care\u201d, adding: \u201cBut where I can\u2019t speak with any confidence positively is about access to healthcare. I can\u2019t speak with any confidence that the right solutions to the future of the NHS will be implemented. There\u2019s been a lot of talk, a lot of reports, over 20 years, but the necessary actions haven\u2019t happened. The majority of my members are angry and frustrated. Some doctors have given up trying to influence anything. That\u2019s a sad state of affairs. They feel people aren\u2019t listening. Ultimately, the solutions must come from those in power, the politicians. The health boards only do what they\u2019re instructed to do by their political masters.\u201d\n<\/p>\n \n READ MORE\n<\/p>\n \n Neil Mackay: Gangsters are terrorising Scotland, but do our politicians care?<\/a>\n<\/p>\n \n Neil Mackay: For some she\u2019ll always be guilty simply of being Nicola Sturgeon<\/a>\n<\/p>\n \n Neil Mackay: Here\u2019s the secret to how the SNP turned Scotland into a one-party state<\/a>\n<\/p>\n \n Neil Mackay: Scots have a real problem with the truth about empire<\/a>\n<\/p>\n \n However, Kennedy notes: \u201cI believe our First Minister, because he told me personally, and our Cabinet Secretary for Health, do realise how serious the situation is, and I believe they\u2019re serious about change. What I\u2019m not seeing is the urgency to make those changes.\u201d\n<\/p>\n \n Is the crisis in the NHS fuelling the far right and leading to anger in society? \u201cThe Scottish people have witnessed deterioration across the board in terms of public services. So the deterioration in the performance of the NHS will no doubt be leading to some anxiety and people\u2019s loss of confidence in their future.\n<\/p>\n \n \u201cPeople are seeing that they\u2019re not getting the access they used to get. So it\u2019s definitely causing people to question the future of the country.\u201d\n<\/p>\n \n When it comes to waiting times for operations and seeing specialists, Kennedy says his patients are going private due to complaints over issue like \u201corthopaedics \u2013 that\u2019s knees and hips; dermatology, that\u2019s skin problems and skin cancers; and gynaecology. There are huge waiting lists for women with serious issues\u201d.\n<\/p>\n \n Patients are waiting \u201cfar too long\u201d for outpatient appointments. \u201cIt\u2019s not uncommon for me to get letters from hospital departments saying \u2018I\u2019ll review this patient is six months\u2019 and a year later the patient comes to see me and says \u2018have you heard anything from the hospital?\u2019.\n<\/p>\n \n \u201cGPs are constantly chasing up the system. Waiting times for operations are getting longer and longer.\u201d\n<\/p>\n \n Waits are also caused by the fact that operation times are now longer, as they are safer, Kennedy explains. Appendectomies once took \u201cmaybe half an hour\u201d. Now, it\u2019s \u201cdone laparoscopically\u201d \u2013 using keyhole camera surgery \u2013 \u201cbut that takes much longer. So where a surgeon might have done 10 to 12 operations daily, they\u2019re now doing four to six\u201d.\n<\/p>\n \n Kennedy highlights waiting times for some cancers, especially blood cancers. \u201cIt\u2019s really worrying what we\u2019re hearing about waiting times for people with blood cancers \u2013 even with the most serious blood cancers, life-threatening blood cancers. Patients are waiting six weeks to be seen by consultant haematologists.\u201d\n<\/p>\n \n Cancer\n<\/p>\n \n PATIENTS \u201cwith conditions that could potentially become cancerous, that would normally be followed up by haematologists in hospital, are just no longer being followed up\u201d. Instead, GPs are told \u201ccan you check this patient once a year and let us know if there are any problems\u201d.\n<\/p>\n \n More broadly, Kennedy says, \u201cwe have a shortage of oncologists \u2013 cancer doctors \u2013 throughout the country\u201d. He notes that breast cancer patients in the Highlands could be \u201creferred to Forth Valley\u201d.\n<\/p>\n \n \u201cPatients are waiting far too long, way beyond what\u2019s safe for them, and way beyond what they need in terms of getting treatment in the time they need to start treatment.\u201d\n<\/p>\n \n He adds: \u201cIt\u2019s obvious to any frontline clinician that we\u2019ve a problem with mental health services. The specialties that have been neglected over the past decades have been general practice and psychiatry. We have a huge shortage of psychiatrists and mental health nurses. It\u2019s a Cinderella service which doesn\u2019t get the attention it deserves from the media, politicians or public.\u201d\n<\/p>\n \n In Inverness<\/a>, for example, 46% of mental health referrals are rejected. \u201cI\u2019ve little doubt the system is so under-resourced and under pressure that the only way doctors can cope is by holding back almost half the people who need to see them, and only focusing on the most serious cases.\u201d\n<\/p>\n \n Those patients \u201cthen end up in A&E departments and interacting with police. Police tell me one of their biggest problems is managing to discharge safely members of the public into mental health services. They find it difficult to find places of safety. We have serious problems with our mental health services.\n<\/p>\n \n Kennedy adds: \u201cMuch of that\u2019s to do with substance misuse, drugs and alcohol. But much is also to do with serious anxiety disorders, depressive illness and psychotic illness.\u201d\n<\/p>\n \n Psychotic patients used to be \u201cadmitted to hospital on the day\u201d. Now, there\u2019s a \u201cstruggle even to get young teenagers seen by psychiatric services\u201d.\n<\/p>\n \n Kennedy believes there\u2019s \u201cabsolutely no doubt austerity has damaged the health of the nation. Most frontline clinicians see links between austerity and ill health. Health inequalities have undoubtedly got worse\u201d.\n<\/p>\n \n He has personally \u201chad patients who have completed suicide because of reductions in their benefits\u201d. The effects of austerity leave him feeling \u201chelpless. One of the saddest things we deal with is the interface between poverty and illness\u201d.\n<\/p>\n \n Due to the crisis in the NHS, staff suffer from verbal abuse and physical violence. \u201cBecause of the frustrations of the public and the limited resources, tensions are rising.\u201d\n<\/p>\n \n Kennedy has faced violence. \u201cI\u2019ve had to avoid flying chairs in my room on occasion, which is quite frightening.\u201d His office has a panic button. \u201cMy room still has the dents in the wall to remind that we\u2019re in a vulnerable position. Violence and aggression occurs far too often.\u201d\n<\/p>\n \n Vaccines\n<\/p>\n \n THE BMA is concerned by \u201cimmunisation rates falling in Scotland\u201d. He says: \u201cWe\u2019re seeing falling rates of childhood immunisations. Uptake of flu vaccinations is going down. Vaccinations are safe, save lives and prevent disease. There\u2019s a risk of resurgence in infectious disease. We must get immunisation rates up.\u201d\n<\/p>\n \n Referring to Donald Trump<\/a> scaremongering over vaccines and autism, Kennedy urges the public to \u201cignore any messages from across the Atlantic\u201d.\n<\/p>\n \n \u201cRenewal\u201d of the Scottish NHS cannot wait until after the next election, Kennedy says. \u201cWe need to decouple improvements in the NHS from political cycles.\u201d Political consensus on rescuing the NHS \u201cneeds to happen now regardless of next year\u2019s Holyrood<\/a> election\u201d.\n<\/p>\nIs time running out for Scotland’s NHS?(Image: )\n<\/p>\n
Nurses and doctors are under ever-increasing pressure amid a backdrop of cuts(Image: )\n<\/p>\n