The SNP must drop ‘Whitabootery’ and face its responsibilities

The SNP must drop ‘Whitabootery’ and face its responsibilities

by Brian Monteith
article from Wednesday 14, February, 2018

WHAT IS IT about politicians, and especially politicians holding government office, that they cannot recognise they are being disrespectful to voters when they resort to “whitabootery”?

Scotland needs to face up to the reality that the need for yet more constitutional debate has long since passed. There is little doubt in my mind that the main domestic battleground this year will be the management and resulting performance of the NHS in Scotland. 

Supplied regularly with official statistics and credible anecdotal evidence that demonstrates a growing crisis in Scotland’s NHS, the SNP is facing an almost daily onslaught of embarrassing facts, worrying trends, and heart-breaking human examples of how its management is failing.  Were the chief opposition parties – the Conservatives, Labour and Liberal Democrats – fail to challenge the government to accept responsibility for its shortcomings and announce how it intends to rectify the problems they would be failing in their duty.

And let us be under no illusion, the responsibility does rest fully with the Health Secretary, Shona Robison and her line manager, Nicola Sturgeon, for this is the Scottish National Health Service that is being discussed. 

As an organisation it is Scotland’s largest employer and the greatest consumer of public funds. Based upon an operational model introduced universally across the whole UK, and ranked regularly by the British people as the institution they are the most proud of, its achievements or failures in Scotland now have very little to do with Westminster – other than the very significant transfer of UK taxpayer funds that maintains its operation at a level Scotland alone could not otherwise sustain. Free Personal Care is just one of many such operational differences funded by the generous fiscal transfer. 

It is Holyrood – through its powers vested in the Scottish Government – not Westminster, that controls how Scotland’s NHS is managed, how its structures are configured, which drugs it uses and who pays for them, what health priorities it chooses, its remuneration of staff and the numbers it trains – and what level it is financed at. We really should stop calling it the NHS and start calling it the SNHS. 

I recognise there are some who claim the independence debate is relevant to healthcare, arguing we could do so much more “if only”, but this is to ignore the SNHS has been deviating more and more from the public’s perception of a “national” UK health service since devolution arrived in 1999. The argument that independence would make the difference is a gross exaggeration designed to deflect attention from our government's own shortcomings, for there is very little it cannot do with Holyrood’s current powers. 

For example the SNHS has not been privatised as a result of Scotland remaining in the UK – contrary to what Dr Philippa Whitford warned us during the referendum – instead it has been managed by the Scottish Government informed by its own interpretation of what Scottish society needs. Sadly, it has been found wanting.  Indeed it is our own Scottish Government that refused to pass on the full uplift in health spending given to it by the Conservative government – a truly shocking scandal it chooses to gloss over.

So when Ruth Davidson, Richard Leonard and Willie Rennie ask Nicola Sturgeon questions about the SNHS she should recognise that as a former Health Secretary herself and now First Minister her responsibility is to answer honestly and fully about how she and the current Health Secretary propose to remedy various crises. Answering with the “whitabootery” of problems faced in the English and Welsh NHS is to abandon the political field of battle where Generals such as herself are meant to show they have better ideas, better solutions and can win their argument. 

It is political cowardice worthy of the white feather rather than the nationalists’ white rose. 

As an argument whitabootery is as pointless as saying the standard of domestic Scottish football is poor but the Irish leagues are far worse. How many Scots avail themselves of Irish football? How many Scots avail themselves of an English A&E or elective surgery (unless sent south to avoid waiting in a longer Scottish waiting list)? 

There also eventually comes a point where examples can be turned on their head – when, say, vaccination rates etc can be better elsewhere than in Scotland, it all depends on ‘whit’ statistics one selects. Speaking recently on Good Morning Scotland Nicola Sturgeon claimed vaccination rates for Scottish doctors, nurses and medical staff were higher than last year but failed to explain why rates were far lower than elsewhere in the UK, and below her own set target. In 2016-17 only 35 per cent of healthcare workers were vaccinated to prevent flu against a target of 50 per cent (that has never been reached) and a comparable figure of 63 per cent for England and 49 per cent for Wales. 

Consider just some of what opposition MSPs have raised in the first two weeks of this year alone: Conservatives demonstrated that even though the SNP promised to end the practice, more than 10,000 ambulances have been dispatched with one crew member on board in the last four years. Last year, the SNHS sickness rate was 7.6 per cent, a third above the target of five per cent and well beyond the private sector average of 1.9 per cent. Hospital beds continue to decline (down from 21,340 hospital beds in 2016/17 against more than 23,000 in 2012/13) but are not replaced by more social care places for the elderly, as these too have declined (down from 38,465 in 2012/13, to 37,746 in 2016/17). 

Labour leader Richard Leonard was right to raise the harrowing treatment of 80-year-old Tom Wilson who waited nearly four hours for an ambulance and spent 13 hours on a hospital trolley after a fall on New Year’s Day. The First Minister answered whitaboot the unprecedented levels of winter demand – but it was later established by Conservatives that A&E demands were higher in May and June last summer

Whitabootery is divisive and mendacious for it forgets how, on many occasions, the SNHS has relied upon accessing operating tables up and down England to ensure it can meet its own targets. We should be thankful for this arrangement rather than seek to rubbish our neighbours whose co-operation and achievements (often under more demanding pressures than our own) we can benefit and learn from. 

Whitabootery also ignores the widely varying standards across the SNHS itself and how our own outcomes, better or not than our neighbours, can be in decline. That surely should be our focus. 

When SNHS cancer treatment waiting times are worse than they were ten years ago, as they are, or when cancer death rates are 41 per cent higher in Scotland’s most deprived areas we have our own challenges to face up to. Looking across the border is not an acceptable answer. To have a genuine debate on the NHS the Scottish Government has to take responsibility for both the good and the bad and come up with how it can deliver an improved service irrespective of what is happening elsewhere. 

Like-for-like comparisons with other health models can be useful, so let us look to France, the Netherlands or Germany – where different structures and procedures appear to produce better outcomes, but let us abandon ‘whitabootery’ that compares lemons with pears and looks for a raspberry as the answer.

Whitabootery must be consigned to the rhetorical graveyard – just as Godwin’s Law consigned the use of glib Nazi analogies to Room 101 on the Internet. Only then will we be according the problems of the NHS the seriousness they deserve.

A shorter version of this article first appeared in The Scotsman.

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