I hadn’t come across the term “moral distress” until this week, when it was used by Dr Iain Kennedy, the chair of the Scottish BMA, during a discussion we were having about the state of the NHS.

It’s a fascinating if disturbing concept, and stems from the financial and institutional constraints that health workers operate within. Their inability to provide a level of care that they believe is reasonable can lead to them experiencing psychological unease, depression and even post-traumatic stress disorder.

The notion of moral distress first came to prominence during the Covid crisis, when 78.4 per cent of doctors felt they were experiencing it. Dr Kennedy said it remains a live issue today: as the NHS stumbles from crisis to crisis, medics find they are simply prevented from helping patients in ways they wish to or think are deserved.

Such might be an inevitable outcome of Britain’s insistence on maintaining a rationed system of healthcare amid an ageing and sickening population, an explosion of expensive new technology, the rising cost of medicine, and the large gaps that are opening up in the NHS workforce. The tensions inherent in this can be seen in the increasing suggestions from within that a system free at the point of need may no longer be sustainable. The head of the Royal College of Physicians in Edinburgh, Andrew Elder, recently said it was “legitimate to ask whether we can afford to provide every treatment available, free of charge and at the point of access”.

It’s clear that most NHS staff, politicians and voters want to maintain a “free” service. But the problems are mounting and not easily solvable. Wherever you look on the NHS dashboard, red lights are flashing.

Statistics released this week show consultant vacancies in Scotland stand at 436 posts, up by 5.8 per cent on last year. The number of posts that have been vacant for six months or more now stands at 238, a 12.2 per cent rise.

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