A very experienced doctor told me a couple of weeks ago that the health of A&E services in our hospitals is a barometer of what’s going on in the NHS. A pulse check, if you like.
On Tuesday we discovered that pressure in our A&E departments across Scotland is worse than England.
With Dundee’s own Ninewells a notable exception, A&E departments are missing their waiting time targets and in some areas, missing them by a long shot.
Last year more than 120,000 Scots waited more than four hours at A&E. Why is this happening?
Firstly, our ageing population. Lots of elderly people are coming into hospital with respiratory and complicated problems that require attention and often admission into hospital.
But the health boards tell me that many younger people are coming to A&E with legitimate complex conditions that need treatment too.
That is at the front door of the hospital, at A&E.
But at the back door, it is difficult to discharge many elderly patients because they can’t go home without the necessary care support, which often has not been arranged by the time they are medically ready to leave hospital.
So there are delays for days, weeks and even months while social work, care homes and families try to put a care arrangement together through a myriad of phone calls, missed calls and emails, with no one person responsible for making this a swifter or easier process.
Congestion in our hospitals is the result, with expensive long stays costing roughly £3,700 a week and few free beds for the A&E doctors to move patients through to the wards.
And neither are there enough doctors and nurses.
A total of 75% of Scottish nurses feel there aren’t enough of them to do the job, so they told their staff survey published before Christmas.
NHS Lanarkshire has nearly 150 nursing vacancies going unfilled and recruiting doctors is an ongoing problem for nearly every health board in Scotland.
On Tuesday, Scottish Labour Leader Jim Murphy and I visited Monklands A&E department.
The consultant was telling us that they struggle to recruit doctors.
I noticed a young doctor smile as he typed his notes into the computer. I thought he knew the solution.
“Young Scottish doctors are in Australia,” he said. “I came home because I was homesick but they make better money out there.”
And herein lies another great policy challenge for the SNP how to retain our health staff in Scotland.
We can’t guarantee the Australian sunshine but what we can give our doctors is research and teaching time so they can build their reputations.
Their contracts don’t allow this and they are simply holding the problems in our health service at bay.
Waiting times in A&E are getting worse, bed blocking is rife and the population is getting older by the day.
Hospitals still don’t work at full tilt. No evening diagnostics, no planned surgery at the weekends, not even discharge at the weekends, making the peaks in admissions on a Monday even harder to manage.
The British Medical Association told me this week that nobody tries to get hold of a doctor on a Monday in Scotland as it is frantically busy.
Scottish Labour has promised 1,000 extra nurses because we know they are needed.
But patients across Scotland shouldn’t have to wait for a change of government. Many people told us that they re-elected the SNP because they were a competent government.
This competence record is being severely challenged now by the problems they have been storing up over eight years in our health service.
Doctors are thanking us for speaking up about this and patients are coming to us with their stories of 12-hour trolley waits.
Women in labour are being transported across the country because maternity wards are full, patients in a surgical ward in Glasgow are sleeping in hats, nurses working with their coats on and there is no running water because the heating has crashed out.
Is this the modern health service we want? The Scottish Government needs to address this urgently.