Diary of a Royal Infirmary consultant leaves politicians running out of excuses over NHS - John McLellan

Royal Infirmary staff weeping, ambulances queuing with nowhere for their desperately sick passengers to go, patients doubled up in cubicles; if anyone doubts Edinburgh’s NHS in in crisis, Dr David Caesar’s diary is all the proof you need.

“Today, we start the day with 86 patients in a space designed for 34, and 50 patients waiting for beds, many over 20 hours into their stay,” the RIE emergency medicine consultant wrote just before Christmas.

“They are on narrow firm trolleys, in cubicles, sometimes doubled up, in the corridor, and on chairs, cheek by jowl, sharing noise, air, respiratory viruses and distress. Dignity feels like a distant luxury.”

Associate medical directors rarely, if ever, publish such searing accounts of a daily struggle against catastrophe, so Dr Caesar’s reports for The Times are themselves a symptom of the unfolding disaster, and it’s a far cry from the days when NHS Lothian communications staff would harangue journalists for accurate reporting.

His observations are echoed by Professor Andrew Elder, the Royal College of Physicians of Edinburgh president, who said in a joint statement with the Society for Acute Medicine that he had “never been more concerned about standards of acute medical care across hospitals in the UK”.

Only 55% of Scottish A&E patients were seen within target of four hours in the week to December 18 ─ the worst ever performance ─ but that figure is an aspiration at the RIE where in the week ending November 27, only 38.5% were seen in the target time.

An emergency debate in the Scottish Parliament is being demanded, but whether Health Secretary Humza Yousaf resigns or is replaced, the problems run too deep for any successor to produce a plan for overnight transformation.

But there is no excuse for not having a plan at all, and there is no sign that Mr Yousaf and his colleagues know how to address long term issues, or indeed accept any responsibility for the current crisis.

The diary of an emergency medicine consultant at the Royal Infirmary Edinburgh has laid bare the crisis in the Scottish NHS , with politicians running out of excuses over the state of both primary and medical care, writes John McLellan.

They blame the UK Government for not providing enough money, despite Scottish public spending per head being 17% above the UK average. But the Institute for Fiscal Studies showed health spending decreased from 22 per cent higher than England in 2000, to just three per cent more by 2020.

But it is more and yet Scots still die on average two years earlier that their English cousins while the SNP remains wedded to gestures, like the free dentistry policy which simply forces dentists out the NHS and patients into the dental hospital. Their free prescriptions give everyone over-the-counter medicine they can buy in supermarkets.

Medical training places were slashed when population trends showed more would be needed. No one believes new health centres will have enough professionals to staff them, while the lack of family doctors has led busy GP practices to ask existing patients to go elsewhere.

It’s true the UK needs a radical plan because a service conceived when the population was 49m, and the average male life expectancy was less than two years after retirement, cannot possibly deal with a population some 20m larger and everyone living around 12 years longer.

But the SNP is responsible for the Scottish NHS and it’s their job to solve the problems in Scotland. As they say, that’s what they get the big money for.