In the Herald today, the above and:
Surgeons, nurses and NHS staff have reacted with anger to a secret blueprint for a massive overhaul of orthopaedic surgery in Scotland. Most only learned of the bombshell report’s existence when The Herald revealed it on Friday.
Ooooh, when is management going to impose this ‘secret blueprint’ on staff?
The plan is still a confidential draft (“Transforming Elective Orthopaedic Care in Scotland 2026–2031”). There is no fixed public start date for the full package of changes, final details have not been published, and the Scottish Government has stated that engagement with staff and trade unions on the draft was always intended. Health Secretary Angela Constance’s response was that boards had been developing the plans following a government commission and that “we are clear we have always planned to engage directly with staff and trade unions on this draft plan
Is there any likelihood the full package will be implemented before 2031?
No.
Why full early implementation is unlikely
- Capital and infrastructure elements (extra theatres at named sites such as Queen Margaret Hospital, capacity expansions, enabling works) normally require business cases, design, construction or refurbishment, commissioning, and staffing. These typically take multiple years even when funding is confirmed.
- Workforce and operational changes (systematic six-/seven-day working, extended theatre days, revisions to consultant terms and conditions/job planning, additional clinics) depend on recruitment, negotiation with staff-side, and sustained capacity. These are rarely achieved in full on an accelerated schedule.
- Structural elements (full elective/trauma separation into sub-specialty hubs and revision centres, regional capacity management under the East/West model) are tied to the broader board reforms, whose detailed design work only began in September 2026.
- Historical pattern: Earlier Scottish National Treatment Centre and elective recovery programmes experienced delays relative to original timelines. English surgical-hub programmes have also been multi-year and subject to slippage on individual schemes.
Because the document remains a draft without a fixed implementation date for the full set of changes, and because official statements indicate consultation was planned, the headline is stronger and more alarmist than the underlying facts support. It is not wholly invented. It is selective framing that presents delayed engagement as secrecy and crisis. That is the sense in which it functions as scaremongering rather than neutral reporting.
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It is very likely that members of NHS trade unions will be part of the group drafting this ‘blueprint’. I suspect that it is one or more of them who has passed a copy of the draft on to the media so that we could have ‘leading’ members of the health unions acting performative rage.
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This is my lived memory of working in General Practice – https://abetternhs.net/2013/05/10/true-history/ – and it has largely disappeared now save perhaps in rural areas. Some (?all) NHS medical specialties still provide a similar service with Consultants rotating ‘on-call’ on a weekly basis in order to have a family life. That’s 168 hours of availability including the day job. Perhaps they won’t be called on by their teams during those weeknights and weekends including all public holidays but try telling that to Consultants in surgery and general medicine. Give the true heroes support or you will lose it all just as General Practice has largely been lost. The vultures are waiting in the wings. Some of those vultures are those who work for the NHS and ‘moonlight’ to ‘private practice’. Including a contingent of orthopaedic surgery, anaesthetics, general surgery and ophthalmology. Audit Scotland are currently reviewing orthopaedic services: https://audit.scot/uploads/2026-08/pb_orthopaedics_as.pdf. Will Audit Scotland mention the ‘moonlighters’ who do so much damage to the NHS?
N.B. Probably a majority of NHS Consultants in Scotland do not work privately. Many who do simply want to reassert their professionalism away from a bureaucracy which often seems inappropriate and over-controlling; some are preserving their income and pension at a time when working full contract or overtime for the NHS can mean a significant net loss of pay (unbelievable but true e.g. incompetent changes to pension taxation by Cameron-Clegg government meant senior NHS Consultants could even, in extreme cases, face bankruptcy for working NHS ‘overtime’ to reduce waiting lists!); a minority in profitable private practice are simply making money and a very small number of Consultants work exclusively privately with no direct conflict of interest. Those such as Anas Sarwar who (in the 2026 Scottish Labour Manifesto “SCOTLAND NEEDS CHANGE” page 22) advocated “purchasing capacity from the independent sector on a short-term basis” are simply perpetuating the problem of conflict of interest between the public and private (“independent”) sectors – stick to privatising the dental sector Lord Anus! This conflict of interest is not just financial. Those who obtain services in the “independent” sector may also ensure higher end named Consultant care while less experienced doctors may often treat patients with equivalent conditions in the NHS*. The phrase used in the NHS was, and perhaps still is, that a medical practitioner is “appointable” i.e. is known to at least meet the minimum skill level required. The supervision and further training of such “appointable” doctors may at times be adversely affected by the absence of their senior colleagues. And, of course, using the “independent” sector is often associated with more timely diagnosis and treatment potentially at the expense of equivalent patients on NHS waiting lists. I wonder what happens when a patient in the “independent” sector develops significant complications while their Consultant is working NHS hours! 😏
True story. Like many doctors I tried (and failed) to live up to my medical oath and have never accepted medical services that my patients could not readily access (and I worked mainly in higher deprivation areas). I would bombard everyone and anyone on behalf of seriously ill patients potentially facing life changing consequences or even death if not treated timeously. I received many high level complaints and warnings, not one of which proceeded to completion because the complainants would have to embarrass themselves and their ‘services’ publicly. On one occasion I received a phonecall from a Consultant saying that they had noted my name on their waiting list and I could be seen at their private clinic free of charge with op to follow on NHS. Probably an intended generous offer but I politely declined. Come operation day and the generous Consultant was not present*. I questioned the ‘appointable’ staff and they had wide experience of working with other specialists that I knew and respected so the op went ahead. And, let’s just say, I’m still suffering the consequences. Like my patients…you really are second class in some areas of the NHS. Identifiable immediately by the poisonous amalgam in your teeth, now almost unique to the UK, instead of white composite.
The entire situation is a farce. Pricing independent schools out of existence at ever increasing cost to the taxpayer while leaving charitable status, 80%+ discount on non-domestic rates and VAT exemption as a gift to the ‘private medical sector’…did you know that NHS hospitals face full non-domestic rates?…utter madness and malice!
Let’s see all of that reformed by 2031. Not holding my breath!
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