No money for birthday gifts as the NHS turns 75

BBC producer Claire McAllister with partner John after the birth of baby Christopher

BBC Scotland's office in Edinburgh has had a lot to thank the NHS for in recent weeks.

My colleague, political editor Glenn Campbell, has been missing in action recently - spending a week in hospital after a serious pothole incident on his bike.

It involved paramedics, A&E and a trauma team, but thankfully he is on the mend.

At about the same time our health producer Claire McAllister found herself in high dependency at the end of a rather complex pregnancy.

Again staff were amazing and delivered an adorable bundle of premature joy - and mother and baby are doing fine.

• The future of the NHS - what do the experts think?

• Five big problems the NHS in Scotland needs to fix

It got me thinking, what would those experiences have been like 75 years ago when the NHS was born?

And I wonder what a future NHS will look like, for a baby born in 2023.

Clearly the health service is still doing an incredible job in increasingly difficult circumstances.

But Covid and its aftermath have really tested a system which has been struggling for many years - and the warnings from the experts about the future are bleak.

The two biggest challenges are how to pay the soaring bills, and how to find enough people with the right skills to meet demand?

Big bills to pay

Earlier this year, BBC Scotland commissioned a poll to find out your views on the health service. Most people who responded said they expected the NHS to remain free at the point of need in 10 years' time and believed that the highest earners should be the ones to pay for it.

In Scotland this year's health and social care budget is £19bn. That is far more than is spent on education, the justice system and transport combined - but it is still not enough.

Already, taxpayers earning over £43,662 pay an extra penny in the pound, with the money going directly to the NHS, raising £129m in Scotland.

But to put that into context, the cost of this year's pay increase awarded to nurses, paramedics and other healthcare workers is more than £500m.

Huge advances in medicine and technology in the past 75 years mean many people can be cured of disease or live comfortably with quite complex medical conditions.

• The patients who gave up waiting on the NHS

That's a cause for celebration but at the same time, health board budgets can't always stretch to offering the most expensive drugs or investing in new buildings or equipment.

Demand on the NHS is now much greater than when the service was being built.

In spite of some world-leading public health policies, Scotland remains a profoundly unhealthy nation.

A third of adults are now obese, and a quarter drink at harmful or hazardous levels.

About a fifth of the population lives in poverty.

More and more of these people will need help with complex combinations of illnesses, including heart disease or cancer, in the coming years.

Recruitment riddle

BBC Scotland's Political Editor Glenn Campbell was in hospital for a week after a serious pothole incident on his bike

Workforce is the second fundamental issue that the NHS in Scotland faces.

The pensionable population of Scotland is expected to rise by 35% by 2043, yet over the same time period the working age population is expected to decrease by 3% and the number of children to decrease by 22%.

There are already significant NHS vacancy rates and a critical shortage of social carers.

I was shown a presentation slide the other day that suggested three in every 20 primary school children in Scotland will have to choose a career in the NHS, just to keep up with the current demand.

Attracting NHS workers from overseas is one option - but at the same time many homegrown clinicians are looking abroad for more rewarding opportunities as the health service struggles to retain existing staff.

Meanwhile, thousands of people are languishing on record waiting lists, wondering whether the NHS is really providing the safety net they were promised, from the cradle to the grave.

Free in future?

It is extremely difficult to see how policy makers can maintain the type of service we've become used to.

And while most people in our BBC poll wanted the NHS to remain free at the point of use, 43% said they would be likely to pay for private treatment if they faced long waits.

In the past year almost 10% had already done so.

But First Minister Humza Yousaf has been clear that he does not want a two-tier health service and that it must remain true to its fundamental principles.

These are issues the whole of the UK faces but many of the professional bodies and unions have been critical of the Scottish government for promising more than is realistically achievable.

And the spending watchdog said the government needs to be honest with the public about what its priorities are, and what the NHS can afford.

So there are plenty of difficult and potentially unpopular decisions to be made.

Do you raise taxes, cut other public spending, or even charge people for elements of care?

If not, the reality is cutting back on some of the services the NHS provides.

It is a big birthday for the NHS but celebrations are likely to be muted - while the hard work goes on.