Health and Social Care
New Social Care System:
The Institute for Fiscal Studies (IFS)
fears that the new care system may make services patchy throughout the country, and that it may not bring the promised improving and harmonising of standards nationwide. Under the new system, responsibility for adult and children’s social care will move from councils to Care Boards. The IFS also fears removing funding from local councils may be hard to calculate accurately.
There are even claims that the new social care service will cause chaos in funding for what are at present local services. The social care sector is to be centralised under government plans, with responsibility moving away from local authorities and into the hands of government ministers via care boards. Millions of pounds will no longer go to local authorities, with some fearing it will be a cash grab by the Scottish government at the expense of local authorities, but Social Care Minister Kevin Stewart says there will be an increase in public investment in social care by 25% over the life of this parliament, the equivalent of over £840 million.
It is clear the new system will be fundamentally different. What is not so clear is how funding local services will be easier under the new system, or how it will be better, or how centralisation will make services more accountable.
The Scottish government may have broken the law over the award of the design contract for the new National Care Service contract, by outsourcing to PriceWaterhouseCooper instead of using its own procurement services which would have given easier access to Scottish based suppliers to supply goods and services to the public sector.
Care Homes Closing
Some care homes are so fearful of rising energy bills that they have closed for good. One such is Broomfield Court Care Home in Barmulloch, Glasgow, and another is Moncreiffe Care Home in Bridge of Earn. Businesses have no energy price rise cap in place, meaning many are facing closure or crippling costs, and it is feared that vulnerable and elderly residents will be forced to move to care homes which are miles away from family, or even move into hospital.
Care homes are mostly funded through the National Care Homes contract which gives them a fixed weekly rate from councils, which has not been amended as energy prices have continued to rise. It amounts to £832.10 per person per week for nursing care and £719.50 per person per week for residential care. Self-funding residents pay between £900 and £1,100 per week. Seventy percent of care is paid for by the government. Age Scotland says that vulnerable residents may end up in hospital, and care home providers say the Scottish government has its head in the sand over the future of care home funding. The Scottish government says the powers to deal with the energy rises lie with the Westminster government.
So far in the UK, only Northern Ireland is providing care homes with extra funding to meet rising energy costs.
Sodium Valproate Scandal
Thousands of babies have suffered birth deformities and developmental problems after their mothers were given sodium valproate, a drug used to treat epilepsy and bipolar disorder, during pregnancy (‘Help us, warn women: Families urge action over epilepsy drug….’, Marion Scott, Sunday Post, 07/08/22). The children suffered defects ranging from spina bifida, spine and skull deformities, cleft palate, webbed fingers and toes, extra fingers, holes in the heart, epilepsy, speech issues and defects of the urinary tract in boys. Incredibly, the drug is still being prescribed and babies are still being born with major problems.
Two years ago Baroness Cumberlege reported on the scandal, urging greater support and financial redress for the victims and better protection for women at risk. About 27,000 women of child-bearing age across the UK are still being given the drug, often without any warnings. She wants women to be prescribed other drugs instead if at all possible. Ten percent of those exposed in the womb are affected by major congenital abnormalities with 40% affected by neurodevelopmental effects.
But so far little has been done to implement Baroness Cumberlege’s recommendations.
From 2019 to 2021 there was an 84% increase in patients funding their own healthcare due to concerns over NHS Scotland waiting times. And almost a quarter of patients in urgent need of a cancer diagnosis are waiting longer than the 62-day target for first treatment. The Scottish government recently announced £10 million to try and improve cancer waiting times.
NHS funding private operations
NHS Scotland is offering private firms to tender for a £150 million contract to carry out operations in NHS hospitals over the next five years in order to reduce waiting times and/or increase health board capacity. Anaesthetics, gynaecology, orthopaedics, cardiology, breast surgery, neurology and other specialties will be covered.
It is also inviting tenders for firms to provide suitably qualified staff to run virtual diagnostic clinics via an online portal and for mental health services. The NHS is also asking for tenders to supply staffed mobile/ modular units to be placed on site to provide maternity and cancer wards, emergency medicine, microbiology labs, intensive care and cardiac surgery.
Clearing the NHS Backlog
Public Health Scotland’s five-year NHS Recovery Plan, far from tackling backlogs, is currently down 1.6% on the numbers from 2021, with elective procedures 27% below pre-pandemic numbers. Half the ten elective National Treatment Centres for such things as hip replacements are behind schedule, with the three due to open in 2022 put back to 2023.
The new chair of the BMA in Scotland has said that clearing the NHS backlog is completely unrealistic without solving the pay and pension tax issues which are currently forcing senior clinicians to quit the NHS early or face tax bills of tens of thousands annually.
Doctors’ Pay Increase
The Scottish government recently awarded doctors 4.5% increase, as recommended by the Doctors and Dentists Pay Review Body which advises the UK and the devolved governments (‘What is fair pay for Doctors?’ Helen McArdle, Herald, 23/07/22). Starting salary for a junior doctor in NHS Scotland will rise by £1191 to £27,653, and for a new consultant by £3939 to £91,473. It will cost NHS Scotland an extra £77 million yearly.
Doctors are not happy, though, as based on the Consumer Price Index inflation, their pay actually fell by 9.1% between 2010 and 2019.
A new NHS app
being introduced through the Scottish government’s Digital Health and Care Strategy will allow patients to view test results and medical letters online and seek health advice but there are concerns over privacy and security, as well as the possible emergence of a two-tier system separating those with the app from those without. The system will not be compulsory, and the app would be downloaded and your identity validated before accessing online services.
Drug treatment still failing in Scotland
Anti-drugs campaigner Peter Krykant says nothing has changed in bringing effective drug treatments, due to among other things third sector drug charities unable to prescribe substitute medication as they can in England and Wales and which has led to much lower death rates.
He also says overdose prevention centres can be delivered within existing Scots law, and wants the promised diamorphine-assisted treatment to be rolled out across the country. The Right to Rehab is a failure as the most effective treatment is within their own communities, not artificially removing people to rehab centres where the ordinary temptations have been removed.
Almost 600 people were diagnosed last year, making nearly 6000 since 2010. Scotland has the highest prevalence of MS in the world, particularly the Orkney Islands, which has over ten times the world average, but the reasons for this are not yet clear.
Cancer Blood Test
The NHS is currently trialling a simple blood test for the over-50s which could prevent 1 in 10 cancer deaths in the UK. The test would prevent 16,000 deaths and could show up to 50 types of cancer. In the trials so far, 30% to 70% of those spotted to have cancer in the trials actually did have it, compared to only 10% of those referred to hospital following routine breast or bowel screening tests.
Working from Home (WFH)
may not be the panacea it is claimed to be. On the contrary, it may well affect mental health due to isolation and even lead to a form of agoraphobia about going out at all, never mind returning to the office. WFH will mean constant interruptions on social media, possibly trying to combine childcare or housework with paid work, and some report always being at the beck and call of their boss. Even Zoom meetings may increase stress rather than reducing it, particularly in areas where internet connectivity is patchy.
Dentistry in Crisis
Millions of pounds earmarked for NHS dental care in Scotland was unspent last year (‘Millions earmarked for dental care goes unspent’, Helen McArdle, Herald, 16/08/22). Even allowing for the funding of Public Dental Services in hospitals, it still leaves £30-£50 million unused, although the Scottish government has disputed this figure.
The Scottish Dental Association says dentists cannot afford NHS work without taking on more private practice. NHS activity was 75% of their work pre-pandemic, reduced to 50% now. During the pandemic, dental practices were offered ventilation grants to upgrade surgeries in return for committing the entire practice to the NHS for a minimum three years afterwards, but only 18% of dentists in Greater Glasgow and Clyde took up the offer.
Nine out of ten dental practices are not taking on NHS patients, and the whole system may be susceptible to fee exploitation due to the way the Scottish government calculates its payments for treatment. Because the government altered the multiplier paid for NHS treatment (paying dentists £1.70 for every £1 of treatment carried out) dental leaders say this encouraged a spike in one-off treatments which were quick to complete, at the expense of treatments which took longer to complete.
Covid limited the number of patients seen but the temporary uplift to encourage people back was cut back in July to 1.3 (£1.30 per £1 of treatment) but dentists argue this does not cover their outlays. Payment by the Scottish government is calculated at the multiplier applicable at the end of treatment, which disincentivised long treatments being started at the 1.7 level.
The Scottish Dental Association has proposed a solution whereby practitioners would spend 60% of their week on core dentistry, with the rest of the time going on fee-per-item NHS work, and private sessions for cosmetic work like teeth whitening. Dental inspections can spot mouth cancers, but the reduction in NHS service means it may go undiagnosed.
NHS dental services are paid by a combination of grants to practices and a fee-per-item payment. The multiplier paid to dentists is currently 1.3 (£1.30 paid to dentists to cover every £1 of treatment) but is expected to be reduced next month.
85% of dentists in Scotland are not taking on new NHS patients. The Links Dental Practice in Bruntsfield, Edinburgh, is going wholly private, with patients told they must pay £21.50 per month to stay on their list from October 1st. The Scottish government has promised to abolish all NHS dentistry charges by 2026, but this will not matter if NHS dentistry is effectively no longer available.
Julia Pannell 30/08/22