NHS Scotland ‘sleepwalking’ to a two-tier system, says BMA

NHS staff at the Louisa Jordan hospital in Glasgow
Scotland is 'sleepwalking' into sacrificing the principle of a health service free at point of use, BMA says - Jeff J Mitchell/Getty Images

Scotland’s NHS is in “permanent crisis” and a “two-tier” system in which the better off pay for care is already in operation, doctors’ leaders have warned.

In a stark warning, Dr Iain Kennedy, the chairman of the British Medical Association in Scotland, warned of a “massive deterioration” in health service performance and savaged SNP ministers over inadequate plans to turn the situation around.

He claimed Scotland was “sleepwalking” into sacrificing the principle of a health service free at the point of use and said the reality was that the wealthy were already going private to avoid huge waiting lists.

He highlighted long waits in Scottish accident and emergency departments, where more than 1,000 patients a week are not being seen within 12 hours, while queues for appointments and operations have also spiralled to unprecedented highs.

Opposition parties said the warning, to be delivered at a BMA summit in Belfast on Tuesday, was a damning indictment of the SNP and made a mockery of John Swinney’s attempt to present his party as guardians of the health service.

“Scotland’s NHS is in a state of permanent crisis,” Dr Kennedy is expected to say. “Winter pressures are here 365 days a year.

“[Between July last year] and the end of April this year, over 58,000 patients have waited more than 12 hours in a Scottish A&E department – that’s 24 times greater than five years ago.

“This massive deterioration in performance is completely outwith the control of our doctors who work tirelessly in traumatic circumstances.”

He said that the statistics showed that the whole health and social care system was “not coping” with the founding principles of the NHS.

He reiterated his call for a “national conversation” on reform but said Scottish government plans in the area lacked “both clarity and urgency”.

“Long waits are forcing those who can afford it, to go private,” Dr Kennedy will warn. “A two-tier health service in Scotland is now beyond question. If you can stump up the cash, then you can get the care you need.

“But we all value an NHS free at the point of use. Yet, Scotland is sleepwalking into sacrificing this principle, threatening the very existence of the national health service as we know it.”

During the election campaign, Mr Swinney has repeatedly warned that Labour poses a risk to the NHS through plans to make more use of the private sector.

He has said Wes Streeting, the shadow health secretary, presents a “clear and present danger” to the Scottish NHS, despite health being a devolved issue.

However, Mr Streeting has accused the SNP of “scaremongering” and has urged Nationalists to take responsibility for what he described as an “abysmal” record on health.

Mr Swinney has also come under pressure from voters who attacked him during a TV election debate over the crisis in the NHS.

According to the most recent figures, there are 534,000 people on outpatient NHS waiting lists in Scotland, a 10 per cent rise in a year and more than double the figure before the pandemic.

In July 2022, Humza Yousaf, as health secretary, announced targets to eradicate waits of over a year for outpatient appointments by March 2023.

They are not close to being met, with 1,302 people waiting more than two years and 46,828 waiting more than one year for an outpatient appointment at the end of March this year.

Meanwhile, a further 158,108 people were waiting for inpatient or day case treatment, with 7,140 of them stuck on lists for more than two years.

Sandesh Gulhane, the health spokesman for the Scottish Tories and a working GP, said: “After 17 years of SNP mismanagement, Scotland’s NHS is in permanent crisis mode and they still don’t have a plan to fix this situation.

“My colleagues in the BMA have been very clear that unless drastic action is taken then the existence of the NHS as we know it is under threat.

“John Swinney needs to stop obsessing over independence and instead focus on tackling the crisis engulfing our NHS.”

The Scottish Government was approached for comment.