Battling the biggest health crisis in a century

It was a year that began with rising drug deaths, growing NHS staffing issues and dodgy hospital builds, but ended with Scotland battling the most serious health crisis to hit the world in a century.

To say the past 12 months in health have been eventful is an understatement.

And all through it, Health Secretary Jeane Freeman has stood strong in the role, despite months of opposition party calls for her resignation.

One year ago, the biggest news in health was Scotland’s ‘drug deaths crisis’. In July 2019, it was revealed Scotland had the highest per capita drug deaths in the developed world, with the National Records for Scotland (NRS) finding the number of drug-related deaths had increased by 27 per cent in 2018.

As the Scottish Government pushed for safe injecting rooms, the UK Government pushed back and organised a drugs summit in Glasgow without informing Scottish ministers ahead of time. The conferences ended up taking place one day apart in February, at the same venue.

The rise in drug deaths was one of the reasons behind news that Scottish life expectancy had stalled. The NRS found life expectancy growth decreased by 2.6 weeks for men and 3.1 weeks for women in 2015-17.

Falling staffing levels also plagued the health system. In September, NHS Scotland consultant and nursing vacancies had hit the “highest level since 2007”, with 4,013 nursing and midwifery positions vacant in Scotland. A Royal College of Nursing Scotland survey found three fifths of nurses were overworked.

In an October report Audit Scotland said NHS Scotland was “running too hot” and needed large-scale change. It revealed the deficit across all health boards will rise to £207m and called for the government to “refocus its priorities” in speeding up health and social care integration and system-wide reform.

And then COVID-19 took hold.

The first case in Scotland was reported on 1 March: a male Tayside resident who had returned from Italy. A BBC investigation later revealed that a Nike conference in Edinburgh at the end of February may have been among the first outbreaks in Scotland.

At the time of print there were about 2,500 confirmed deaths from coronavirus, with about 4,200 deaths where COVID-19 was mentioned on the death certificate.

More than half of the deaths occurred in care homes, overtaking hospital deaths in early July. The ‘scandal’ of care home deaths will be investigated in a public inquiry into the Scottish Government’s handling of the pandemic, but also led to calls from Labour for a nationalised social care service.

During the pandemic A&E wait times decreased, with 95 per cent of all accident and emergency cases seen within four hours as of May – the first time in three years that target had been met. However, in the first few weeks of lockdown the number of people attending A&E plummeted by more than half. This led to the launch of the ‘NHS is Open’ campaign encouraging people to attend hospital for emergencies.

Meanwhile, cancer waiting times fell short of target for the seventh year. In April, urgent referrals for patients with possible cancer symptoms  were 72 per cent below average.

Two million people in the UK have been awaiting screening, tests and treatments since before lockdown began, Cancer Research UK figures in June showed.

By the end of July, one in three cancer patients said their treatment had been impacted by the effects of COVID-19 on the health system. Macmillan Scotland said the figures were “a stark reminder that the system wasn’t working as it should long before the pandemic.”

But cancer wasn’t the only disease to be sidelined by the pandemic. With Scotland’s health service put into emergency mode for almost half of 2020, many people with pre-existing conditions struggled to secure appointments, procedures and tests.

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The health crisis also increased awareness of health inequalities in Scotland. Those living in deprived areas were more than twice as likely to die from COVID-19, the NRS revealed. Research then showed that people from South Asian backgrounds in Scotland were almost twice as likely to die from coronavirus, leading to calls for more health services and guidance for South Asian communities.

Scotland’s mental health system was already struggling under the weight of demand pre-COVID. In December the Scottish Government was accused of “failing young people” as figures showed a fall in the proportion of children seen within 18 weeks of a mental health treatment referral.

The number of children waiting more than a year for mental health treatment in mid-2019 doubled compared to 2018. At the time the Scottish Children’s Services Coalition called for “dramatically increased investment in mental health services to address the current mental health crisis”, pointing to “very low” investment in child and adolescent mental health services.

After months in lockdown, in June SAMH told Holyrood there needed to be “a massive strategic rethink of how the care and treatment system in Scotland funds itself, delivers itself, meets the demand that was already there, and the demand that will be increasing upon it”.

Pre-COVID, one of the biggest health scandals was the bungled build and failed opening of £150m Edinburgh’s Sick Kids hospital. As the costs billowed – a £11.6m ‘settlement agreement’ paid out to contractors by NHS Lothian to fix problems; £139,000 in staffing costs – the opening was delayed until autumn 2020, but the virus outbreak may cause further delays.

Alongside this was the Queen Elizabeth University Hospital (QUEH) infection scandal, with several patient deaths linked to issues with the ventilation system. The health board was placed under special measures, along with NHS Lothian. A public inquiry was announced into issues at the two hospitals in September 2019.

These issues led to repeated calls for Freeman’s resignation from opposition parties. Speaking to Holyrood about this early in 2020, she said she was “frustrated by that kind of headline”, saying it “stops us having a mature, grown-up conversation about the challenges that health faces in Scotland, in the UK and globally”.

Several of Scotland’s health leaders departed from their posts in 2020. The first was Scotland’s chief nursing officer, Fiona McQueen, who is “moving onto a new chapter” in her life. Then – the most controversial – Scotland’s chief medical officer, Catherine Calderwood, resigned after she was caught leaving Edinburgh to visit her second property in Fife. The face of Scotland’s public campaign, Calderwood had repeatedly told people to stay at home before violating the rules herself. The next to exit was NHS chief executive Malcolm Wright, who resigned due to illness in May after less than a year in the role.

As the Health and Social Care Alliance Scotland told Holyrood: “Pre-COVID, there was an expectation that this would be the year where we may see reflection, a critical appraisal of where we have got to in achieving the ‘2020 Vision for Health and Social Care’... the pandemic has halted that.”

However, it has also “raised issues and questions which leave us better placed to have that type of frank discussion.”

Just days before lockdown, Scottish Government national clinical director Jason Leitch told Holyrood: “The most important thing to say is coronavirus is nobody’s fault... you can’t shut your country down and hope it goes away.”

After months of restrictions and changes to the healthcare system, Leitch’s final point still rings true: “The virus is global, the virus is here and the virus will be here for a long time.”