Tag: crisis

Concerns raised as record number of pupils in Scotland are identified with additional support needs

The Scottish Children’s Services Coalition (SCSC), an alliance of leading providers of specialist care and education to vulnerable children and young people, has raised concerns over an increase in the number of pupils identified with additional support needs (ASN), amounting to over a third of the pupil population.

Set against a backdrop of budgetary cuts and an ongoing lack of support, it has called for increased resourcing to address this growing need, which is also having an impact on surging levels of classroom disruption and violence.

The SCSC has also voiced concerns over a declining number of those with complex needs receiving a co-ordinated support plan (CSP), the only education plans that are legal documents. This is despite a Scottish Government promise that there would be no decline in the numbers of those receiving them.

The figures were released yesterday (12th December) in the Scottish Government’s annual census of pupils and teachers in publicly funded schools.1

These show that the number of pupils with ASN, such as autism, dyslexia and mental health problems in 2023 has reached a record high of 259,036. This represents 36.7% of the pupil population, rising from 131,593 in 2013. 2 This represents almost a doubling (96.8%) in numbers over the past decade.

An increase in demand is however set against a background of spending cuts and a lack of specialist ASN teachers, support staff and the resources needed to support these children and young people.

This is exacerbated by the damaging ongoing impacts of Covid-19 lockdowns and the cost-of-living crisis, which have had a disruptive impact on many of those with ASN, who disproportionately come from the poorest backgrounds. There has also been an increase in those experiencing mental health problems.

The SCSC has also raised concerns over a decline in the number of those receiving a CSP. These are statutory education plans prepared by local authorities to identify and ensure the provision of services for children and young people with complex or multiple ASN.

The only education plans that are legally enforceable documents, CSPs require services such as education, health and social work to work together to give a child or young person the support they need. This provides some guarantees of entitlement to additional resources and legal redress, placing statutory duties on local authorities to review and ensure the provisions contained within it are being met.

Despite a Scottish Government promise that there would be no reduction in the proportion of pupils receiving them since their introduction in 2004, there has been a significant fall in the number of pupils with a CSP. Declining from 3,279 in 2013 3 to 1,318 in 2023 4, this amounts to a drop of 59.8%. and is a reduction from 2.5% to 0.5% of those with ASN.

The coalition has called for an expansion in access to CSPs, with the Scottish Government, local authorities, health and other relevant agencies collaborating more effectively to ensure that those requiring such a legal plan receive one.

This needs to be supported by the necessary resourcing, and increased awareness and understanding of CSPs by families or carers and professionals.

A spokesperson for the SCSC commented: “While more children and young people are being identified as having ASN, this is against the increasingly challenging backdrop of a lack of specialist teachers, support staff and the resources needed to support them.

“This is having an impact in terms of surging levels of school violence we are witnessing. Increased support is critical, especially post the Covid-19 pandemic and the damaging impact this has had on many of our children and young people, exacerbated by the cost-of-living crisis, all of which is hitting the poorest hardest.

“We are also concerned that despite an increase in the numbers of those with ASN we are experiencing a decline in the use of CSPs, which are legally enforceable and designed to support those with the most complex needs.

“The Scottish Government, local authorities, health and other agencies need to work in collaboration with the private and third sectors to provide the necessary resourcing and support to address the needs of children and young people with ASN. They must also work together to ensure that those who are entitled to a CSP receive one.

“With those with ASN drawn disproportionately from poorer neighbourhoods, if we are to genuinely close the educational attainment gap, they must get the care and support they need when they need it.”

Dentistry: COVID impact on scale unseen in any other part of NHS

The British Dental Association has warned MSPs the pandemic has had an unparalleled impact on NHS dentistry, that leaves the service facing an existential threat. 

As the professional body prepares to give evidence to the COVID-19 Recovery Committee inquiry into NHS dentistry today (22 June 2023), it has published new analysis showing the scale of the backlogs.

Initially closed to routine care, and then facing exacting Infection and prevention control guidelines that reduced patient throughput, lost capacity on the high street exceeds general medical practice and secondary care, resulting in backlogs that will take many years to clear:

  • Dentistry has lost over half (52%) of its capacity since lockdown, when comparing examinations delivered since March 2020 with typical levels pre-COVID.
  • For GPs, that figure is just over 30% (when looking at lost face-to-face appointments). It is just over 6% for hospital outpatients and in terms of volume, inpatient care appears to have already recovered lost ground.
  • By any measure captured in official data, whether it is examinations or Statement of Dental Remuneration (SDR) activity claims, Scotland has lost more than a year’s worth of NHS dentistry.
  • Ongoing access problems are fuelling backlogs, with patients presenting with higher levels of clinical need. In recent BDA surveys over two thirds (67%) of dentists cite higher needs patients requiring more clinical time as a key issue on return to ‘full’ capacity. The only comparable problems are those concerning recruitment and retention of dentists (61%).

Dentist leaders say it will be impossible to restore pre-pandemic activity without radical change. The low margin/high volume model the service works to was incompatible with working through the pandemic and cannot form the basis for a meaningful or sustainable recovery.

This leaves the service at a crossroads: with a contract that is unfit for purpose, underfunded, overstretched and facing the challenge of deep and widening oral health inequalities. BDA Scotland fear that an exodus of dentists from the     NHS is already in motion. This shift is going unseen in official data, that counts heads not the amount of NHS work dentists do. These workforce statistics give an NHS full-timer the same weight as a dentist doing one NHS check-up a year.

Recent BDA surveys indicate only 1 in 5 (21%) of practices have returned to pre-COVID-19 capacity. The professional body say hard limits on restoring capacity, and the existential threats to NHS dental services require a proportionate response from the Scottish Government.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “COVID hit dentistry like no other part of the NHS in Scotland.  

“We’re not asking for special treatment, just a proportionate response. One that recognises the scale of the backlogs and the existential threat to this service.

“NHS dentists are already walking away from a broken system. There can be no recovery without reform.”

No time to delay: RCEM calls for meeting with new Health Minister

‘The Emergency Care system is not functioning as it should’, RCEM says as Emergency Department performance drops

Responding to the latest Emergency Department performance figures for Scotland for March 2023 Dr John-Paul Loughrey, Vice President of the Royal College of Emergency Medicine Scotland, said: “The data show another drop in performance. This means more patients facing longer waits, more delays to care and more harm.

“We cannot continue to see this occur, we need to be seeing improvements in performance and a reduction in delays to care. This is a signal that the current interventions and actions are not having the time critical impact that we need to be seeing.

“The Scottish Government needs to understand that hesitancy to take the necessary actions will impact on the safety of patients and their care. Emergency care is not functioning as it should, no patient should face a 12-hour wait in an Emergency Department.

“We know what needs to be done: ensuring social care is responsive and able to support the timely discharge of patients; expanding acute bed capacity across Scotland; retaining existing staff while recruiting more staff into Emergency Medicine. These are the solutions laid out in our campaign Five Priorities for UK Governments for #ResuscitatingEmergencyCare.

“We would welcome an opportunity to meet the new Cabinet Secretary for Health and Social Care, Michael Matheson MSP, to put forward these solutions and the means to tackle the crisis in Emergency Care. We cannot consider this to be winter pressure anymore; this is year-round, and it continues to cause harm. We must do better for patients and staff, there is no time to delay.”

The latest performance figures for March 2023 for Emergency Departments across Scotland show:

  • There were 110,446 attendances at major Emergency Departments
  • 64.5% of patients were seen within four-hours at major (Type 1) Emergency Departments
    • This is a decrease of 1.9 percentage points from the previous month, and a decrease of 3.9 percentage points when compared with March 2022
    • 39,253 patients waited over four-hours in major Emergency Departments, this is an increase of 22.3% from the previous month
  • In February 2023, 13,750 (12.4%) patients waited eight-hours or more in an Emergency Department
    • This is an increase of 33.9% from the previous month, February 2023, and the highest figure so far this year
    • When compared with March 2022, this figure has increased by 24.8%
    • This is equal to more than one in eight patients waiting eight-hours or more in a major Emergency Department
  • 5,739 patients waited more than 12-hours before being seen, admitted, discharged, or transferred
    • This figure has increased by 25.6% from the previous month, and an increase of 39% compared with March 2022

Audit Scotland: Integration Joint Boards ‘face significant workforce pressures and financial challenges’

Scotland’s Integration Joint Boards (IJBs) face considerable financial challenges and immense pressures on their workforce, says public spending watchdog Audit Scotland.

IJBs have reached the point where significant transformation will be needed to ensure the long-term capacity, financial sustainability and quality of services individuals receive.

IJBs plan and commission many community-based health and care services. Demand for these services is increasing, in part due to demographic change and support for people with increasingly complex care needs.

The number of care hours for those aged over 65 reached nearly 25 million in 2021/22. The proportion of care services reporting vacancies increased by 11 per cent to 47 per cent, with a 30 per cent turnover of staff each year.

Most IJBs underspent on providing services in 2021/22. This was largely because of difficulties in recruiting staff, which led to unplanned vacancies, and pandemic-related reductions in service provision. The reductions in service provision were likely to have contributed to an increase in unmet health and social care needs.

In 2021/22 IJBs returned significant surpluses, with reserves doubling to over £1.3 billion. This was mainly due to additional funding received late in the year for specific policy commitments, including Covid-19. The Scottish Government are currently exploring options to recover around two-thirds of the unspent Covid-19 money held in reserves.  

Across Scotland, IJBs have a combined projected funding gap of £124 million for 2022/23. 

To be financially sustainable in the longer-term, IJBs must reduce their reliance on reserves. All IJBs must put in place detailed plans that clearly show how they will achieve the needed ongoing savings on a recurring basis and support urgently needed service transformation. 

William Moyes, Chair of the Accounts Commission said:  “Change is needed now – it cannot wait for a National Care Service. Action is needed to tackle funding pressures, which are under increasing stress from rising demand and cost pressures.

“The workforce challenges are considerable, with mounting unmet need. 

“We need to see services focus on prevention, with appropriate funding in place to transform the way services are delivered and to improve lives. “

Local government organisation COSLA agrees.

COSLA Health & Social Care Spokesperson, Councillor Paul Kelly, said: “Today’s report from Audit Scotland is concerning and highlights the enormous pressure our health and social care infrastructure is under.

“People across Scotland rely on vital health & social care services every day, and it is critical that there is meaningful investment in the system which ensures their long-term capacity.

“We must ensure focus remains on front-line service improvement and sustainability, rather than the bureaucratic structural change presented through the National Care Service Bill.”

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NHS Dentists issue open letter to new First Minister

Following the election of Humza Yousaf as SNP leader and his swearing in as First Minister, dentist leaders in Scotland have called for immediate action to ensure the beleaguered service has a future.

The leadership election has delayed the timetable for reform of the low margin/high volume system dentists work to, that has left providers facing the risk of delivering NHS care at a financial loss. In an open letter the British Dental Association has stressed that without immediate action the exodus from NHS dentistry will accelerate.

A recent survey of high street dentists across Scotland showed over half (59%) have reduced the amount of NHS work they do since lockdown, and four in five (83%) say they plan to reduce or further reduce their NHS commitment in the year ahead.

In the letter BDA’s Scottish leadership state: “In 2021 the SNP made a promise to the Scottish electorate: free NHS dentistry for all. The decisions you take in your first 100 days will effectively determine if that promise is going to be kept.”

Cats Protection warns of animal welfare crisis as people cut down on vet visits and insurance

Cat owners are cutting back on pet essentials such as vet care, vaccinations, and insurance as a result of the cost of living crisis, according to new research from Cats Protection. 

The leading feline welfare charity is seeing a rise in people giving up their cats for financial reasons and is warning there could be an animal welfare crisis as a direct result of the cost of living.

Cats Protection has launched an online hub to support owners in need with a raft of information including how to look after your cat on a budget and how to access help with costs.

One in three* cat owners surveyed said they feel “greatly impacted” by the cost of living crisis, while nearly one in five (18%) said they were spending less on vet services, including missing essential vaccinations or not microchipping their pet.

Meanwhile, nearly one in three (31%) of cat owners said they are concerned about how they would pay emergency vet bills if their cat became sick or injured, with nearly one in five (18%) concerned about paying for routine vet treatment. The charity says this represents tens of thousands of cats whose welfare could now be at risk. 

A quarter of cat owners (25%) said they are spending less on pet insurance because of the cost of living and 17% are concerned about paying for insurance in the future. 

Alison Richards, Head of Clinical Services at Cats Protection said: “We know the cost of living is having a huge impact on people across the country, with many cat owners making difficult choices to make ends meet. Cutting back on insurance or vet treatment can ultimately lead to higher costs if a cat becomes injured, gravely unwell, or even pregnant.

“We’ve launched a new information hub with lots of tips and ideas for looking after your cat on a budget, with everything from how to make free cat toys to how to access help with costs such as neutering. We want to provide access to information and resources that can help every owner look after their cat.” 

Cat owners also reported cutting back on spending, with more than half spending less on eating out or takeaways, days out, clothes, drinking and holidays. The survey also showed that 60% of owners feel their cat is a source of comfort to them during a difficult time.

Adoption centres are also seeing a rise in people giving up their cats for financial reasons. 

Nicola Murray, deputy manager at Cats Protection’s Harrow Homing Centre, said: “The cost of living is having a greater impact on animal welfare than Covid. We’ve got desperate people turning up on our doorstep every week and our waiting lists for people wishing to give their cat up are several weeks long.

“People need more information and support for managing their cats during this time as no one should have to give up a much loved pet during a time of crisis.”

*Survey of 3,011 cat owners in the UK, conducted by Basis on behalf of Cats Protection. Fieldwork completed in December 2022. 

NHS ‘still in the depths of crisis’

“We remain extremely concerned about our patients and their safety and for the welfare of staff who are struggling”, RCEM says

Responding to the latest monthly Emergency Department performance figures for Scotland for January 2023, Dr John-Paul Loughrey, Vice President of the Royal College of Emergency Medicine Scotland, said: “The monthly data make clear we are still in the depths of crisis.

“While it is true that the data for January 2023 show improvements when compared with December 2022, December was the worst month on record. We are relieved that we have mitigated against a repetition of December, but we remain extremely concerned about our patients and their safety, and for the welfare of staff who are struggling.

“January saw continued high numbers of extremely long waits; the third highest number of 12-hour waits on record. While the weekly data from February also show that we cannot let up in our requirement for substantial improvement.

“As the Scottish leadership election begins, tackling the crisis in Emergency Care as well as the crisis in the wider health and social care system must be a priority for the next First Minister. In 2022, a total of 55,095 patients waited 12-hours or more in an Emergency Department in Scotland.

“Analysis by the College shows that consequently, in 2022, there were an estimated 765 patient deaths associated with these dangerously long waiting times – equal to an estimated average of 64 each month. This is entirely unacceptable and a marker of a system that is not functioning as it should.

“To tackle this, in Scotland we urgently need a restoration of the acute bed base, that means opening an additional 1,000 staffed acute beds where safely possible.

“There are also significant shortfalls of staff in Scotland. The Emergency Medicine workforce needs at least 100 more consultants, as well as senior decision makers, ACPs/ANPs/Physician Associates, junior doctors, and vital nurses.

“We welcomed the expansion of Emergency Medicine medical training places in Scotland by 10, but this expansion is considerably short of what is required and there has yet to be any commitment to maintain this each year.

“This winter continues to be the most challenging yet for the NHS in Scotland. A failure for meaningful action now will prolong the risk to patient safety and maintain these dangerously long waiting times at the detriment to staff who are already burned out and exhausted. 2023 must be the year that we see political will translated into action that improves patient care and conditions for staff.”

“There can be no denying it; the Emergency Care system is failing”

RCEM launches campaign to resuscitate Emergency Care as polling reveals the public’s lack of confidence in UK government’s policies to tackle the crisis

The Royal College of Emergency Medicine has outlined five priorities for UK governments to tackle the crisis in Emergency Care, after polling carried out by Ipsos on behalf of the College found 59% of respondents expressed a lack of confidence that the UK Government have the right policies to tackle long patient waiting times in A&E departments in hospitals.

The campaign launches amid the worst Emergency Care crisis on record, as reflected in A&E performance figures across all four-nations.

Five Priorities for UK Governments to #ResuscitateEmergencyCare lays out what UK governments must focus on to tackle the crisis, improve patient care, retain staff, and prevent harm.

The five priorities are:

  • Eradicate overcrowding and corridor care for patients
  • Provide the UK with the Emergency Medicine workforce it needs to deliver safe care
  • Ensure our NHS can provide equitable care to emergency patients
  • Focus on evidence-based interventions to tackle overcrowding
  • Introduce meaningful and transparent metrics to facilitate performance and better outcomes for patients.

More patients than ever before across the UK are facing long and dangerous waits. It has been widely reported that crowding, corridor care and long waiting times for patients in Emergency Departments are associated with patient harm and patient deaths.

The public are acutely aware of the issues and pressures in A&E departments, with an Ipsos poll, commissioned by the College, showing that:

Nearly half of those polled by Ipsos expressed that they did not feel confident they would be treated in an appropriate area if they personally had a medical emergency in the next week that required them to attend their local A&E.

Meanwhile, two-thirds did not feel confident that a hospital bed would be available if they personally had a medical emergency in the next week and needed to be admitted to hospital.

Dr Adrian Boyle, President of the Royal College of Emergency Medicine, said: “There can be no denying it; the Emergency Care system is failing and not functioning as it should.

“We can argue about numbers and calculations of excess deaths or we can work together and take the urgent and necessary action to prevent any further harm or deaths occurring. Patients and staff are rightly concerned, they deserve to see honesty and meaningful action from our political and health leaders. This is our plan to tackle the crisis.

“The roots of the problem lie in the lack of adequate capacity in hospitals, lack of staff, and lack of social care in the community. Since 2010, more than 29,000 beds have been removed from the system despite the increasing complexity of population healthcare needs.

“While for many years, social care has faced devastating cuts, meaning patients medically ready to leave hospital do not have the support they need to leave – so they reside in hospital for longer than they should preventing others from being admitted.

“The inability to discharge patients and the inability to admit patients is causing severe exit block – our hospitals are completely gridlocked, meaning Emergency Departments are becoming dangerously crowded and patients are facing extremely long waits.

“These delays and crowding impact heavily on the existing workforce, which has been stretched to its limit for too long. There are significant shortfalls of staff in Emergency Medicine; Emergency Departments across the UK are not safely staffed and the public recognise that.”

Polling shows that just 18% of respondents surveyed agreed their local A&E had enough staff to care for them in a timely way while just 23% expressed agreement that their local A&E had enough staff to care for patients in a safe way.

Dr Boyle said: “Clinicians are doing all they can and what they can to bridge the gap between an under-resourced system and the quality of care patients require, but it’s plain as day to anyone that we have too few staff.

“We are in a dire place right now, but it is fixable. We know what needs to be done to tackle the crisis and improve patient care, but this requires sustained and continued cross-party political willingness and investment to engage with the issue and tackle it root and branch.

“Our campaign to resuscitate Emergency Care shows the way forward for governments, with five key priorities to address. The first priority must be on improving flow through our hospitals to end corridor care and overcrowding.

“UK governments must open more staffed beds, where safely possible, and run hospitals at no more than 85% bed occupancy. In tandem with this, UK governments have been right to invest in community and social care but this can no longer be short-term; we need sustained expansion, resource and funding for social care to ensure patients are discharged safely and promptly when their medical care is complete.

“There must also be recognition of the impact of the crisis on the workforce, they do excellent work, but they cannot continue to flirt with burnout or this will lead to burn away. UK governments must urgently work to retain our highly-skilled frontline clinicians – but they must feel supported, listened to and valued.

“Lastly, performance is at an all-time low and metrics are currently documenting a failing service. Together with the expansion of capacity and resourcing of social care, we must see a renewed effort to improve performance and meet the four-hour waiting time target in Emergency Departments.

“We cannot afford to be in a performance vacuum any longer, metrics must have meaning and drive improvement and better patient care. In England, this must start with monthly publication of 12-hour waits from the time a patient arrives – as it is in the rest of the UK – rather than the misleading and dishonest current metric which measures 12-hours from the time a decision to admit a patient is made.”

Dentists: Latest figures reveal depth of Scotland’s access crisis

The British Dental Association has called on the Scottish Government to fix the broken system underpinning NHS dentistry, as new data reveals little sign of a recovery in attendance and ever-widening health inequalities.

Figures from Public Health Scotland show participation rates – contact with a dentist within the past two years – continued to fall. On 30 September 2022 just 50.4% of all registered patients had seen an NHS dentist within the last two years, still down on the 52.6% seen in 2021, and a considerable reduction from almost two-thirds (65.1%) in 2020. The participation rate among registered children was higher than for adults (65.7% compared to 47.2%).

The gap between the most and least deprived areas in Scotland continues to grow, with the new data showing record inequalities in participation rates. In September 2008, the gap in child participation between the most and least deprived areas was three percentage points; this had increased to seven percentage points by 2010, eighteen percentage points (55.3% compared to 73.1%) in September 2021. The figure now stands at twenty percentage points (55.9% compared with 75.8%).

The BDA has warned that lower levels of participation will inevitably translate into a higher dental disease burden, with deep oral health inequalities expected to widen even further given the cumulative impact of limited access to services, the temporary suspension of public health programmes, and the impact of lockdown diets. Lower participation will reduce the chance of picking up early signs of decay and oral cancers at routine check-ups, and delays in treatment will mean higher costs to the NHS and worse outcomes for patients. 

Registration rates remain high due to lifetime registration – over 95.4% of the Scottish population were registered with an NHS dentist in September 2022– but the percentage of children registered fell marginally. 

Free NHS dental for all remains a key Scottish Government policy. BDA Scotland has long warned that a return to a ‘business as usual model’ – low margin and high volume – will put practices under unsustainable financial pressure, with soaring running costs raising the risk of closure or movement to the private sector.

BDA Scotland stresses that Ministers must continue with additional financial support for practices, set to end on 1 April 2023 to support dentists and their teams as they work through the historic backlog of dental care and until a new, sustainable funding arrangement for NHS dentistry is in place. This data follows recent reports of a growing exodus of dentists from the NHS.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “Patients in Scotland’s poorest communities are paying the price for the crisis in dentistry.

“The Scottish Government must not try to hide behind positive sounding registration figures. The reality is patient participation remains on the floor, and inequalities are set to widen.

“Dentists are reconsidering their futures working in a broken system. NHS dentistry is on the critical list, and real reform won’t wait.”

Stopping “haemorrhaging” of crucial NHS staff must be an urgent priority, says BMA Scotland

‘Sticking our heads in the sand – or using the NHS as a political football to exchange snappy soundbites – will not cut it anymore‘

The number one “quick fix” priority for Scotland’s NHS as we move into 2023 must be the retention of our invaluable healthcare professionals, the chair of BMA Scotland said today (Wednesday, Dec 28th).

Dr Iain Kennedy said any plan for further recruitment, investment in the systems and aspirations of improvement will “fall flat on its face” unless there is a laser like focus on keeping the experienced staff our NHS already has.

Dr Kennedy, who was speaking as he delivered his annual festive message for doctors, added that the need for an open discussion on the NHS is now greater than ever.

His renewed call for a national conversation on the future of the health service comes as BMA Scotland shares more than 100 testimonies from doctors about what working in the NHS is like at the moment and their concerns for what the future holds.

Comments included:

  • “There have been a number of critical incidents in the last six months involving unsafe staffing levels. The acuity of the workload has increased. Patients are generally getting sicker and more complex, but we have less resources or time to care for them. It’s hard to keep them safe. I wouldn’t want to be an inpatient at the moment, and hope everyone in my family remains well for the foreseeable.”
  • “It feels unsafe – because it is. It’s not safe for patients, and it’s not safe for staff either. I have gone from being a passionate committed GP to being a shadow of my former working self. I want to leave the profession and I am devastated by this.”
  • “Things are very bad. Chemotherapy can only be delivered four weeks after seeing a consultant because of a chemotherapy nurse shortage. Radiotherapy preparation scans can only be done two weeks after seeing a consultant because of lack of radiotherapy staff/physicists – and it’s another two or more weeks before radiotherapy can actually be delivered.”

Dr Kennedy said: “The NHS is haemorrhaging crucial staff – staff who we urgently need now more than ever before – and the government must step up to stop it. They can talk as much as they want about recruitment of staff, of investment in the system or of plans for improvement, but every single one will fall flat on its face unless there is a laser like focus on keeping the staff we have.

“That is why the retention of healthcare professionals – keeping them in the service – needs to be the number one priority in terms of the quick fixes to help us just make it through this winter with the NHS in Scotland somehow intact.

“I desperately want to be optimistic and forward looking, to set out some hope for the future – for the medical profession that I am so proud to be a part of, and the Scottish health service that I am equally proud to work in.

“But it’s not easy to find that indication of a brighter future – especially after reading the, frankly, harrowing comments from some of my NHS colleagues about what they are experiencing day in, day out. No one working in the health service would give me any credibility if I gave an upbeat description of the way our NHS will, or can, get better and how the working conditions of those caring for the people of Scotland will miraculously improve.

“All the statistics tell us that it’s a desperate state of affairs. Things are as bad, or worse, than they have ever been. Winter is a meaningless term now – this entire year has been winter.

“But looking beyond the statistics, looking at the people behind the statistics, the picture being painted is even more grim and concerning. The experiences my colleagues have shared speak louder than anything I could say, and anything any official stats could imply.

“We face crises across workload, workforce, working conditions, pay and pensions – all of these are hitting efforts to retain doctors, which we are already short of across both primary and secondary care. Hospitals have too many vacancies – indeed the current vacancy rate for consultants alone is 14.32% – and GP practices are falling over, with the Scottish Government not even close to being on target to deliver their promised 800 additional GPs by 2027.

“In the face of everything else pay and pensions are – incredibly – fairly quick fix issues. The government can make a decision to improve pay for NHS workers. And the UK Government can finally once and for all sort out the pension taxation issues that penalise senior doctors across primary and secondary care and force them to cut hours or face massive and unexpected bills.

“These two things will make a difference in staff retention – junior doctors will feel more valued and be more likely to stay in the NHS instead of looking to move abroad where they will be paid more and have a better work life balance.

“Senior doctors will be less likely to reduce their hours and more likely to work waiting list initiatives if they know they won’t receive a huge tax bill for doing so. We are beyond crisis point now – urgent action is needed to save our NHS and that simply must focus on investing in the workforce.

“Looking beyond that, of course we need to finally get a proper long-term workforce plan in place. But even more fundamentally we need, as a whole society, to grasp the nettle, face up to hard truths that have been brushed under the carpet for too long, and have a proper grown up, depoliticised national conversation about the future of the NHS in Scotland.

“Sticking our heads in the sand – or using the NHS as a political football to exchange snappy soundbites – will not cut it anymore.

“It’s clear we need to reflect on what we ask of our NHS and the levels of funding we, as a country, are prepared to provide to meet those asks, and to ensure the health service stays true to its founding principles and remains free at the point of delivery. The current approach of pushing insufficient resources harder and harder, then blaming staff when standards fall has failed and is failing patients every single day. I know doctors across Scotland are suffering moral injury as a result.

“Let’s stop putting healthcare workers in the impossible and insidious position of having to constantly be apologising and being the bearer of bad news.

“We need politicians on all sides to be brave and act – by bringing us together and finally actually properly talking about a plan for a future NHS we can all confidently get behind. And a better NHS will be better not just for Scotland’s doctors, but for the many people who rely on it for care.”