Nursing Scotland back to health?

Most people in the Republic would be taken aback if their family doctor told them they could not have an appointment for two …

Most people in the Republic would be taken aback if their family doctor told them they could not have an appointment for two days. If they were asked to wait a week or more, they would quickly look for another doctor - or take themselves off to the nearest casualty department.

Dr Chris Rowlands, who is Lanarkshire's doctor of the year, offers appointments to his patients within 48 hours. But in many Scottish practices, he says, "some often don't offer appointments for up to seven to 10 days. It's almost the norm."

In Scotland, the GP service is free for everybody, under the National Health Service. In the Republic, it is free for less than 40 per cent of the population.

The lesson for the Republic, perhaps, is that extending the medical-card scheme to more groups of people, or covering GP visits through health insurance, could mean many more people in doctors' waiting rooms.

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That, in turn, could mean shorter consultation times - the average in Scotland is nine minutes - and an end to same-day appointments unless more doctors can be recruited - but Scotland already has 17 per cent more GPs per capita than does the Republic.

And, says Rowlands, "there's a difficulty in getting people to come into the profession". Two local practices advertised for more than a year for replacements for retired partners.

His experience with hospitals will sound familiar to Irish ears. "Our waiting times are ridiculous. In orthopaedics, it is not unusual to wait for a year to see a specialist before you get onto the waiting list."

Most hospitals have too few nurses, which he attributes to a proliferation of short-term contracts. Long waits in casualty are also common. "A wait of 14 hours occurs with monotonous frequency."

Scotland has 20 per cent more hospital doctors than the Republic, which would need 400 to 500 more consultants to bring it up to Scottish levels, according to a comparison produced for the report of the Forum on Medical Manpower at the start of the year.

Nursing levels are not significantly higher, however - about 5 per cent - and nursing shortages cause cancellation of surgery and closure of beds, according to Jim Devine of Unison, the healthcare trade union.

Pay seems partly responsible. Other careers, such as teaching and the police, offer far higher salaries than nursing. One-third of student nurses drop out before they finish their degrees, partly because fitting in their academic work and their practical work on wards brings stresses and deprives them of an opportunity to take up outside jobs.

Pay may be a less important factor in the move out of nursing than a feeling of being undervalued, however. The 52 per cent of nurses in the survey who said they had seriously considered leaving the NHS placed the feeling of being undervalued ahead of pay.

Yet Scottish nurses have more scope for prescribing treatments than their counterparts in the Republic, and it was announced this summer that the range of treatments for which they can prescribe is to be extended.

The significance of this is that some observers say midwives are leaving the Dublin maternity hospitals not because of pay but because their role has been diminished as that of doctors has increased.

The Scottish experience suggests the Republic has a long way to go before it begins to address this feeling of being undervalued, as well as showing that it has a long way to go to build up GP numbers, so family doctors can take on an extended role.

In other words, a glance at Scotland teaches us the same old lesson: there is no quick fix, just a long march, with luck in a sensible direction.