My brush with premature death came a couple of years ago at 30,000ft en route to Australia – my heart had finally decided to protest.
In those moments, you remember that you are a west of Scotland male and that appearances must thus be upheld: the reputation of Glasgow is on the line here. So you are all wise-cracking stoicism – “I’ll need to put more lime in my Bacardi” – and all that malarkey. Your insides are in ribbons, though, and you’re trying to remember the last time you went to confession.
And then you encounter that which you had only previously heard tell of: the wonder of the National Health Service and the compassion and dedication of those upon whose mercy your survival now depended. I have never yet heard anyone, either directly or indirectly, complain about their treatment at the hands of a doctor or nurse in Scotland (and Australia).
When people you know first encounter the NHS, they tell you how uplifting the experience was in terms of the quality of one-to-one care they received from health professionals in a service that is disproportionately burdened by the effects of austerity. Yes, of course they are paid to do this, but that doesn’t even begin to cover the gentleness of these strangers.
So, few of us were surprised that patient satisfaction was deemed to be at an all-time high in last week’s NHS report by the public spending watchdog, Audit Scotland. The report also said that bed-blocking was falling and that hospital death rates were down. These, though, were thin shards of light in a report elsewhere consumed by gloom.
In all but one of the Scottish government’s eight NHS areas of priority, targets were missed. These included the four-hour A&E target and the referral-to-treatment times for cancer. The number of patients waiting more than 12 weeks for an outpatient appointment had increased by more than 300% in the last five years and by twice that for inpatient and day-case treatments.
Over the next few weeks, these numbers will be pitched relentlessly at Nicola Sturgeon each time she gets to her feet at first minister’s questions. The siren voices will be at their most shrill when they come from the Tories. This is a party that, in England and Wales, has been dismantling the NHS by selling off assets to property firms and awarded Richard Branson a £700m contract to provide 200 types of NHS and social care services to more than 200,000 people in Bath and north-east Somerset. This has fuelled existing fears about private health firms expanding their role in publicly funded health services. To the Tories, the NHS is not a national asset providing equality of care to rich and poor alike – it is a monument to out-dated socialism that must be brought under the unbending regime of the free market.
In Scotland, you can’t accuse the government of failing to support the NHS or of hollowing out its centre, as the Westminster Tories are doing. NHS spending in Scotland takes up 43% of the Scottish budget. Here, it’s a matter of competency. Sadly, the SNP is in a state of rigor mortis when it comes to deploying anything resembling a fresh approach to solving old problems. It is also why Scotland’s most disadvantaged pupils have been betrayed, owing to a total eclipse of innovation in the government’s education policy.
Basically, the Scottish government needs to get real. Nicola Sturgeon insisted that there were signs that reform was starting to take effect. What reform? Her health minister, Shona Robison, has said that Scotland’s five new elective centres will be part of the solution. No, they won’t. The health profession is at a loss to understand why these are needed. The issue is the patient flow in hospitals, stemming from delays in them being discharged.
One senior health professional told me last week: “Yes, there is a backlog for operations, but the issue is the front and back door – not the bit in the middle. They are trying to solve the wrong problem and bringing on these new centres will only add to the problem. In addition, there is a huge problem with a lack of doctors across parts of the system. If they are moving planned care into these new elective centres, how are they going to staff them?”
One solution to this, you might think, is preventing already well-paid doctors doing private work. However, this is a government with a curious attachment to private health and education.
Many of the government’s myriad plans and their fabled “teams of experts” aimed at addressing recurring problems have never progressed. When these troubleshooters go down the mines they are never heard of again. Planning is completely disjointed, according to Audit Scotland, with strategies coming thick and fast at GP level, health board level, regionally and nationally. If the health minister was serious about moving more activity into the community and out of acute hospitals (as is claimed) then surely that would free up space to do all the planned work. So why choose to spend millions building the new elective centres, instead of just reconfiguring the existing ones?
And what has happened to the flagship policy on the integration of health and social care services? I’m hearing that health chief executives, an anointed band of pension-chasers with under-scrutinised CVs, are redirecting cash to establish joint care services to achieve waiting times targets.
According to Audit Scotland: “In 2015/16, the total health budget was £12.2bn, 40% of the Scottish government’s budget. Although the budget increased by 2.7% in real terms from the previous year, it is not keeping up with growing demand and the needs of an ageing population. In addition, NHS boards continue to face increasing pressures from rising staff and drug costs.”
The Scottish government can’t keep throwing money at this. Robison says that it’s not all about the money and that change is required. Yet the party’s stated rationale for raising income tax is to give health even more. If the extra money bought us smartness and cleverness then it would be money well spent, for those commodities are in short supply in this Scottish government.
