By Caroline Gardner, Auditor General for Scotland
As the NHS reaches its 70th birthday, the signs of strain are unmistakeable. We all rely on it at critical points in our lives, and survey after survey shows how highly we value it. But the needs of an ageing population, healthcare costs that grow faster than the rest of the economy and increasing staff shortages – all mean that the NHS needs to change to survive.
The number of Scots over the age of 85 will rise by 64% by 2030. And as we get older, we’re less likely to need treatment for a single health problem, and much more likely to have a range of conditions that need to be managed rather than cured. That means caring for people at home rather than in acute hospitals.
Clinicians, politicians and the public all recognise this, and the National Clinical Strategy is about providing more care in or near people’s homes. But many of the problems we’re seeing now – longer waiting times in A&E, missed targets for outpatient appointments and hospital treatment, delays for people who are ready to be discharged – show that change isn’t happening fast enough.
Integrating health and social care should help, but it’s not enough. The NHS is all about people – the people needing care, and the workforce providing it. To keep people safely at home and avoid unnecessary hospital admissions, we need to understand their individual needs and what matters to them.
That starts with GPs, and nurses and social workers who work alongside them. They’re best placed to know the patients who need help, spot problems early, and respond quickly. That might mean adjusting medication, liaising with a local voluntary organisation like Care and Repair, or calling in a hospital-at-home team.
We all want that sort of care. But too often, when problems arise, the only option is the A&E department, leading to an emergency admission and, at best, a long period of rehabilitation before returning home.
Two things are needed if we’re going to turn things around. First, the people working in primary and social care need time to provide that sort of tailored care. That’s better for patients, and it makes the work of doctors, nurses and carers more satisfying. And second, people right across the NHS, councils and government need to lead an honest conversation about why things need to change and how much better we can do.
Doing things to people doesn’t work, especially on a subject as important as the future of the NHS; let’s see what we can achieve by doing it together.