MR Taylor’s impassioned letter on the NHS in Scotland is like the curate’s egg – good in parts but misses when he tries to point the blame of operation cancellations on “NHS” doctors moonlighting in the “private sector”.

The reasons operations are often cancelled are more complex than simply doctors “moonlighting”.

For a standard surgical operation in theatre, you will need a minimum of a registrar, a second surgeon in support, scrub nurse, surgical nurse, theatre technician, blood technician, radiographer on standby, pharmacist, anaesthetist, anaesthetist tech and, of course, a patient.

If any of these are missing, the operation cannot happen. Then there are the technical issues in an operating theatre that go wrong – filtration, air conditioning, equipment failures or extra time cleaning up after unexpected emergency “dirty” operations.

Then there are cancellations of non-urgent operations due to the need to treat higher-risk conditions, all before taking into consideration holidays, days off or sickness.

As for NHS contracts: in 1948, Mr Bevin put a clause in NHS doctors’ contracts which allows all hospital doctors to opt out of a percentage of their NHS income to do private work, to buy off the BMA’s consultants committee’s initial opposition to the NHS.

I spent five years training prior to qualifying and, during my career, was constantly uprating my understanding of advances in my particular field in terms of pharmacy, equipment, operating techniques and delivery of care. Like many of my fellow professionals, more often at my own expense than the NHS’s.

Within the NHS dental contract (Scotland), a dentist is free to do as much or as little NHS work as they wish as they are a private contractor, given it remains a predominantly fee per item contract. If NHS fee rates fail to keep up with dental inflation rates, then dentists either do the treatment and try to make up the loss elsewhere or only offer private care. Remember, dentists basically run a SME and are solely responsible for the salaries, taxes, running costs, equipment, building upkeep and materials they use. All of which has to be covered by NHS fees. I would suggest that to stay viable and take home the minimum net income recommended by the BDA for dentists, dental surgeries will need to be turning over in excess of £200 per hour per clinical surgery to stay in business. Since the 1990s, NHS provision in Scotland has been maintained by dentists mixing private and NHS work using the former to subsidise the latter.

The biggest problem is the UK has never trained enough “homegrown” doctors, nurses, dentists and medical technicians to ever meet the NHS in the UK’s actual staffing needs. Since 1948, it has always relied on medical migrants to make up the staff numbers. Cut off the most recent source of medical migrants – the EU – and you find yourself where the NHS across the UK now finds itself, understaffed with all the knock-on impacts on the current staff this brings: disillusionment, burn-out, increased levels of “sick days”, ceasing employment and, in increasing numbers, emigration to countries where they are clearly more valued than in the UK.

The idea that anyone is bound to any employer “because” is firstly contrary to any individual’s human rights but is a call for indentured servitude, also known as slavery.

Peter Thomson

via email

I APPLAUD Brian Lawson’s long dedication to the independence cause, and sympathise with his ongoing health problems (Letters, Oct 22). There are many families who are experiencing delays to treatment, and my own wife has been waiting nearly a year to have cataracts done, and it will be longer yet. Our own local general hospital’s ophthalmology department is virtually closed and we know why, so it has to be staffed by peripatetic specialists from the Lothians. The problem is not money, the money is there for premises and equipment, but you cannot hire qualified staff off the shelf if they are simply not there.

Mr Lawson implies that Brexit should not now be a problem after six years, but it very much is and will be until Scotland can rejoin the EU – there are thousands of business owners, students and holiday-makers who will testify to that. I’m sure Humza Yousaf would dearly love to rehire some of the thousands of health workers who left after Brexit, but neither he nor the SNP government have the power; that is reserved to a callous government in London.

If Mr Lawson chooses to reply to this letter, I hope he will offer solutions to his criticisms and not introduce red herrings such as ferries or anything else the Scottish Conservatives are always whinging on about. I know my own solution – independence, and fast.


Walthew Duns