THERE were few responsibilities that weighed more heavily on me during my years as first minister than stewardship of the National Health Service.

Indeed, my first job when the SNP was elected to government in 2007 was health secretary, and the NHS, always important to me and my family, just as it is to virtually every family across the country, has had a special place in my heart ever since.

All of us have relied on the NHS at some point in our lives or had loved ones who have done so. And many of us, me included, have family members who work in it.

It is no exaggeration to say that it is our most cherished institution, and with good reason. However, in the month that it reached its 75th anniversary, we must also acknowledge that the NHS is under more pressure now than at any time in its history.

One obvious reason, though not the only one, is the impact of the Covid-19 pandemic. The decision in early 2020 to cancel non-emergency care was necessary.

With a potential tsunami of serious illness caused by the virus coming our way, it was essential to free up hospital and intensive care capacity to deal with Covid patients. However, inevitable though the decision was, the consequences of it are still being felt.

The backlogs for treatment are considerable and will take time to reduce. Indeed, that is why the new elective treatment centres that are starting to open, like the one in Fife that I visited on my last public engagement as first minister, are so important.

Covid is a massive part of the pressure that the NHS is under, but it is not the only cause of that pressure.

Indeed, even before Covid struck, the challenges in the NHS were real. These challenges are to a significant extent, the result of rising demand for healthcare. When the NHS was founded in 1948, the average life expectancy in the UK was around 68 years old.

Today, it is 81. And as people live longer, they often develop multiple health issues, needing more complex care when they are admitted to hospital.

Also, diseases that would once have been seen as a ’death sentence’ – like cancer – can often now be treated with ever more effective drugs and interventions. Indeed, just this week, we heard welcome news of a drug that can slow down the progress of Alzheimer’s.

Of course, the fact that people are living longer, and treatments are available that allow us now to live with diseases that would once have taken our lives quickly, is hugely positive. But it does increase, and make more complex, the demands that are placed on the NHS.

If that is the diagnosis, what then is the cure? Without seeking to underplay the complexity of the challenge, I would highlight three key themes. Two of them are already being prioritised by the Scottish Government, and the third is being done as far as the Scottish Government is able, but it needs the Westminster government to act too.

First, we must value the staff who work in the NHS, first and foremost because they deserve it, but also to make sure we can continue to recruit.

One of the saddest sights in recent months has been NHS staff in other parts of the UK forced onto picket lines. When I was first minister, I made it a priority to do everything possible to agree to pay deals and avoid strikes.

It is to his credit that my successor has continued this approach. As a result – and while we should never be complacent – not a single day has been lost to strikes in NHS Scotland over this past year.

Second, we must press ahead with vital reforms to how care is delivered on the NHS. Enabling more people to be treated at home or in the community when that is clinically appropriate, through initiatives like Hospital at Home, is better for them and ensures that hospital beds are there for those who do need inpatient care.

Separating planned and emergency care, the purpose of the new elective treatment centres, is also important to ensure that scheduled operations are less likely to be cancelled when emergency pressures mount.

And, of course, better alignment of health and social care, and more consistent standards across social care, is the purpose of the proposed National Care Service.

All these reforms are vital. But to cope with rising demand, the NHS also needs a step up in capacity, and that requires a significant injection of extra cash. The Scottish Government is doing its best to deliver that, with record increases in investment, made possible in part by a more progressive approach to income tax. But as Westminster still holds the purse strings, it needs to act – doing so would be right, and it might also allay fears that some right-wing Tory politicians are happy to let the NHS wither.

Bluntly, all politicians have a duty to act now to ensure that those who come after us will be able to celebrate the 150th anniversary of the NHS – and many more after that.