Reform Scotland

Former NHS Scotland Chief Executive says the NHS cannot meet current and emerging demands

Former NHS Scotland Chief Executive says the NHS cannot meet current and emerging demands


Paul Gray, former Chief Executive of NHS Scotland, today says that NHS Scotland cannot meet the current and emerging health challenges, and is not designed to do so. 

In a blog for Reform Scotland, the independent non-partisan think tank, Gray says that the NHS was always going to be overwhelmed without reform, and that the Coronavirus pandemic has precipitated the current situation, rather than caused it.

Gray writes:

The intersection between demography, population health status, funding, and availability of the right skills in the right place, was going to mean that the system would be unsustainable in the next 2 to 3 years anyway.

In his blog, Gray also calls on politicians to change the nature of their debate, saying that:

“…unless the opposition is prepared to go beyond beating the government of the day over the head with the present situation, and unless the government is willing to engage constructively in radical change and stop arguing about increasing investment (record investment in something that isn’t working will not make it work)…we will stay on this merry go round.

Finally, Gray calls for Scotland to learn from international systems of healthcare including the Jonkoping system in Sweden, the Buurtzorg model in the Netherlands, and the NUKA model in Alaska, which are examples of integrated systems being delivered at a local level, with less need for central control.

Commenting on the release of his blog, Paul Gray said:

This is not 2019 and it is certainly not 1948. Previous models of care are increasingly lost in the mists of time and demographics and public expectation, and the more quickly we grasp that, the sooner we will deliver the reforms that are needed. The people currently delivering health and care services have responded brilliantly to the current challenges – we need to hear their voices and the voices of citizens in relation to the reforms that are needed as well.

“I hope that my blog helps to bring about a fresh conversation. I believe in a public health and care system, but we need a new collective version of what that is. 

“NHS Scotland requires radical surgery.

“It is time for us to look to Sweden, the Netherlands, Alaska, and other international examples, to embrace local decision-making, to promote the contribution of the voluntary sector, to recognise where the private sector adds value, and to create a health and care service for the future, with access, quality, and sustainability at its core.

Chris Deerin, Director of Reform Scotland, said:

The health and care sector is perhaps the area on which policy makers should focus most, yet ironically it is also the issue which attracts less sensible debate than any other.

“Paul’s background as a servant to a public health service is unparalleled, and his blog should therefore serve as a foundation on which policymakers of all political backgrounds can build.

“There is no time to wait.