Health - The NHS

The topic that has been raised with me the most was the NHS.

 Many people have said that access to their GP was extremely difficult, and the experience not always satisfactory, the main reasons I was given were:

Difficulty at getting an urgent appointment even when they called early in the morning.

Getting an appointment with the same doctor who knew your health history so that you didn’t have to constantly repeat the issues.

Some complained about being told they had to fill an e-consult before they could get an appointment - several people said they didn’t have access to the internet to do this, others said they found the questions difficult to answer so gave up.

A number of older people and disabled felt they were being dismissed, with things such as it is just your age or made to feel they were a burden and they were taking appointments away from people who needed them more.

The local surgery had been closed and merged into a bigger surgery some distance away which meant you either needed to get a bus, taxi or had to have a car or get someone to give you a lift. For low-income families, disabled, the elderly or those with chaotic lives it was a real barrier to accessing their GP.

Other related comments were around having to go other locations for blood tests, vaccinations, dentists. 

During the various televised debates it was recognised by the various parties that the above were issues but some of the solutions were not necessarily helpful. The response that I have received the most criticism of was the walk in clinics suggested by the SNP, The majority of people that I spoke to think that the investment should go into supporting and investing in local GP practices.

Mr Swinney said we have more GPs, the numbers I have found are variable, some support this comment although it is a marginal increase, other figures which quote full time equivalent suggest it is less but over all it is reported that the target set by the SNP in their pledge to increase the headcount GP workforce by 800 GPs by 2027. Will not be met.

GP practices are also experiencing high vacancy rates. During 2024-25, 14.4% of GP practices responding to the General Practice workforce survey reported a vacancy at their practice.  

At the same time, the number of patients continues to rise year on year. In April 2025, there were over 6 million patients registered with GP practices in Scotland, 7% more than in 2014. This results in an ever-increasing workload for GPs. In 2024 a single full-time GP was responsible for 1,681 patients – nearly 160 more than in 2013, amounting to a 11% increase.

GPs have tried to be creative on tackling the growing number of patients with the use of technology but clearly from some of the feedback I have received this doesn’t work for everyone and it is often the most vulnerable that fall through the gap. 

The other areas with in the NHS people have been very animated about were waiting times for referals, appointments, diagnoses and treatment. Many people said they had used their savings to get private scans, operations because the wait was too long particularly for people who were waiting for scans and tests for suspected cancers, other who needed hip or knee replacements and were in constant pain and at risk of irreversible damage. 

Elective care in Scotland is facing severe pressures. Waiting lists for both outpatient and inpatient treatments in Scotland increased rapidly after the start of the pandemic but have not yet begun to fall.

Having reached a peak in September 2024 when the total number waiting for inpatient and outpatient treatments reached over 728,500, the number of patients waiting fell to 718,000 in March 2025, some patients can be on a number of waiting lists but even with this in mind the numbers are still extremely high.

The proportion of outpatients who had been waiting more than 12 weeks for an appointment stood at 59% in March 2025, up from 25% in March 2019. 

Similarly, the proportion of patients who had been waiting over 12 weeks for inpatient (or day case) admissions stood at 67% in March 2025, compared to 29% in March 2019. The legal Treatment Time Guarantee states that health boards must ensure that patients receive inpatient and day case treatment within 12 weeks from a diagnosis and agreement of treatment.

Even before the pandemic, however, the proportion of people waiting for over 12 weeks had been increasing, indicating that pressures on elective care preceded the pandemic.

Patients waiting for cancer Services continue to witness them operate significantly below the standard of 62 days from urgent referral to starting cancer treatment. In the quarter ending in March 2025, only 69% of eligible people received treatment within 62 days, compared to 81% in March 2019 prior to the pandemic. The 95% target for this measure has not been met since 2012.

Performance against the 31-day standard, from decision to treat to treatment, is generally much better, with 94% of patients receiving their first cancer treatment within 31 days from the decision to treat in the quarter ending in March 2025.

Other concerns raised were waiting times for an ambulances to arrive, waiting times in ambulances before getting into A&E, waiting times in A&E to be seen and people waiting on trolleys in hospital corridors before they can get a bed.

Emergency care in Scotland is also facing substantial pressures. A&E performance was already a challenge prior to the COVID-19 pandemic: The A&E target of 95% of patients being admitted, transferred or discharged within 4 hours of arrival had not been met since August 2017. However, from summer 2020 onwards, performance against the target significantly worsened, reaching a low of 62% in December 2022. There has been little improvement in A&E waiting times since then. In May 2025, 72% of patients were admitted, transferred or discharged within 4 hours of arrival at A&E. However, there have been challenges over what constitutes admission, does moving someone out of A&E into the corridor waiting for a bed constitute admission. In a recent BBC interview with 3 women from the medical profession who explained being left in a corridor is not only degrading for the patient and harder for the medical staff to manage proper care but that there is an increased chance of dying the longer you are left in a corridor.

Final concerns that were raised, the lack of mental health services, the lack of a specialist stroke unit in Aberdeen that can carry out a Thrombectomy, something that is highly time sensitive often most effective with 6hrs of the onset of symptoms. Ninewells has a unit but only operates Monday to Friday 9am-5pm, the hours need to be extended to 24 hours 7 days a week and we need a unit further North given the time sensitive nature of the treatment. This would be a spend to save for the NHS and life changing for the patients affected.

A subject that was raised which indirectly involves the NHS was Social Care in particular care homes, respite care and care packages.

There are around 2000 people stuck in hospital who can’t get home because there isn’t a care package in place, or a place in a care home available. The delayed discharge is not only is distressing for the patient but can’t create a sense of dread about going home as they have become to a greater or lesser extent institutionalised. The financial cost of delayed discharged to the health service is £1.2m per day. The SNP wasted £30m on an abandoned National Care Service which was meant in part to resolve the issue of delayed discharge, not only was money wasted but several years of “waiting to see”. We have also see the cancellation of 300 places in Glasgow to train care workers, we have seen the number of care homes reduce from 1220 in 2015 to 1003 in 2024, we have seen council and NHS provision for rehabilitation have to close due to financial pressure.   

Potential Solutions

There are always opportunities to do things differently, to improve processes and cut out waste and to learn best practice from other medical establishments. What I do have an issue with is when Health Boards are criticised for funding challenges when they have never been properly funded from the start and new policies/promises are made to the public that haven’t been fully considered as part of the wider context of the delivery of health services foisted on health boards.

I think we will have to make some difficult decision if want to retain the NHS and its ability to provide the care we need and want. There has been a lot of tinkering around the edges which has cost a lot of money but produce very little sustainable change. 

We need an honest conversation about free prescriptions, we can’t continue to give prescriptions for low cost items such as paracetamol which cost the Health budget £23m in 2024-25 which worked out around £9 a packet when you can get them for around 35p in the supermarket. We may want to consider a charge for one off prescription of £5, excluding children/students/pensioners/low income households. The majority of people I spoke to would support a charge for one off prescriptions if the amount was sensible. Those on long term medication would continue to receive it without charge. Whilst the one off prescription charges wouldn’t cover the cost of the medication it would make a contribution to sustaining the NHS. Free car parking again I think we need to rethink this, if we charge a £1or £2 pounds for parking at the hospital this can contribute to the maintenance of the car park and grounds, security in the hospital and even help towards the cost of cleaning, allowing the money that currently comes out of the hospital’s budget for these purposes to be redirected to frontline services. The parking charge could be varied for people who are visiting patients who are in long term, this previously happened. I don’t believe we should charge staff for parking. We need to tackle delayed discharge, this may mean spending now to save in the long term. We may need to reopen some of the step down/rehabilitation building, we should consider paying more to our care workers who do an amazing job which will make it a more attractive career choice and get more people joining the profession. If we don’t increase the numbers of care workers, programmes such as hospital at home will not be sustainable, the use of the Red Cross will not be a long term solution to our problem. We also need to look at some of the benefits we are giving people to buy in packages of care and see how we can balance this with people who are unpaid carers. It maybe that an option worth exploring is for the person giving the care to become the official carer and receives some training and a salary which may allow them to give up a job and this would become their main work, part of the agreement would be to provide 4 weeks respite per year. The benefit to the carer is they could choose to make this their job rather than trying to fit in work and caring, the person they care for would have consistency of the person looking after them, the benefit to the care system is this would negate the need for a care package/carers, which potentially reduces delayed discharge, would help with the shortage of carers, and in the long term save money. 

We have an amazing workforce in the NHS that strives everyday to do the best by their patients, politicians need to do their best by them both.