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Doctors must have say on demographic challenges

Doctors must be at the centre of clinical service development if the NHS is to survive the challenges of changing demography and an ageing population.

This is the message of a BMA submission to the Scottish Parliament’s finance committee. BMA Scotland calls for an ‘open and informed dialogue’ about what the NHS can and cannot afford to deliver.

The finance committee inquiry Fiscal Sustainability: Demographic Change and Ageing Population is considering the impact on public finances of issues such as the provision of health and social care, housing, pensions and the labour force.

The BMA submission says demographic change is affecting the NHS because of the increasing workload and demand for services brought about by an ageing population, and because public sector staff — including doctors — are being expected to work longer.

It says: ‘Given the physically and mentally demanding nature of the work carried out in the NHS, the BMA and other trade unions have expressed concerns about how this will affect the NHS workforce in the future and their working patterns.’

The BMA is currently developing evidence on this issue for the government’s Working Longer Review, which is examining the implications of a later retirement age under the pension reforms.

Unjustified pensions reforms

The finance committee submission warns that the current attacks on the NHS pension scheme are unfair and unjustified.

The association adds: ‘Employers will have a responsibility to ensure that there are suitable measures put in place for end of career working arrangements, so that those in their late 60s are not under the same physical or mental pressure as a much younger NHS worker.

‘For example, a surgeon may not be as physically able to undertake a five or six-hour surgical procedure at the age of 68.’

The association says more resources will be needed to cope with the challenges of an ageing population, and says a coordinated system of community, hospital and residential care is required.

It cautions against introducing more bureaucracy, but adds: ‘Now more than ever, the NHS needs to effectively harness the unique skills that doctors have, by enabling GPs and senior secondary care doctors to take a central role in planning and developing clinical services and work collaboratively to deliver real benefit for patient care.’

The finance committee will hold evidence sessions on the issues in the next parliamentary session.

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In Parliament

Care services minister Paul Burstow has welcomed the Dilnot report but highlighted elements which were not considered including personalisation, prevention and quality of care.

He said that the government’s vision is for a social care system which invests time into wellbeing and quality of life, and has a clearer focus on outcomes.

Of the current cross-party discussion on funding reform he said that there will be necessary trade-offs stating that ‘there’s no free lunch to be had in how to implement funding reforms.’