When considering reform of the NHS and social care, a quote from Socrates comes to mind: “The secret of change is to focus all of your energy not on fighting the old, but on building the new”.
This was in evidence in abundance, last week, when I attended the conference Enlighten organised with Chest, Heart and Stroke Scotland, and which took place at the Royal College of Physicians of Edinburgh, of which I am a Fellow.
As doctors and medical professionals, we have had enough of “fighting the old”. We know what’s wrong. Together with colleagues providing a commentary for the Wealthy Nation, Healthy Nation publication, we identified at least nine areas or aspects of the NHS in Scotland where the people of Scotland are being served poorly, from overall health outcomes through staffing to the provision of primary, secondary and public healthcare.
We have moved on to talking about how we “build the new”. To help that endeavour, we want to learn from other European countries such as Germany and Sweden. They have different models of how healthcare is funded, but in both countries responsibility for funding and delivery of healthcare is decentralised, there is an allowance for a mix of public and private provision, and there is better retention of staff beyond the age of 60. As a result both have superior outcomes to Scotland across most areas of healthcare.
We think we can start by studying Germany and Sweden in closer detail, and learning lessons.
However, we are also cognisant of the politics of our time. Although the opinion polling commissioned by Enlighten for last week’s conference, carried out by Diffley Partners, showed that the public have a nuanced understanding of the NHS’s predicament, and are ready and keen for change, politicians are still in a fix. Six months out from an election, they are disincentivised to advocate meaningful change, because there will always be an opponent ready to accuse them of causing harm to ‘our NHS’.
As doctors we need to understand that, and use these six months effectively. We need to create a forum with which politicians across all parties can engage after the election is over and a government is in place.
This forum – in effect, a Commission – should be led by the medical profession and should take to the government and the opposition a blueprint for a new NHS which can deliver the outcomes the nation is entitled to expect.
The medical profession and the political profession need to agree to implement it in the national interest, and if the latter need to use the former for political ‘cover’, then so be it. It is a price worth paying to “build the new”.
Professor Alan McNeill FRCS(Urol), FRCP(Ed), FFSTEd co-authored an essay as part of the Wealthy Nation, Healthy Nation collection of essays published by the Centre for Policy Studies. He was a Consultant at NHS Lothian University Hospitals. The full collection of essays can be read here.