Scotland's NHS must come before the constitution

Scotland's NHS must come before the constitution

by Brian Monteith
article from Monday 1, December, 2014

WHILE the Smith Commission’s work is vital if we are to heal the nation’s painful divisions following the referendum, its proposals should not distract us from the most vital task at hand – solving Scotland’s social ills.

When devolution was proposed it was often said that the days of blaming Westminster would now be over, that we would have to stand tall and take responsibility for education, health, housing, policing and much more. Unfortunately the constitutional navel gazing has not disappeared. Holyrood had the ability to vary income tax but gave it away, and while it retains the power to abolish or cut business rates significantly it tinkers at the edges while dreaming of cutting taxes it does not control. Likewise, while having complete managerial and financial control of the NHS and the powers to extend the welfare state, such as with free personal care and ending prescription charges, many politicians still blame Westminster for NHS Scotland's failings. 

Despite repeated warnings about the state of the nation’s health, about the challenges of a growing elderly population that is itself living longer and the consequential demands placed upon limited resources, the danger remains that when the Smith Commission publishes its recommendations healthcare will again be relegated. Faced with a general election in 2015 and a Holyrood election in 2016 our politicians will be tempted to argue over the Smith Commission’s recommendations and the subsequent legislation rather than recognise our healthcare system is the public's number one priority.

In many ways devolution has failed Scotland, for if we were to compare Scotland’s public services with the rest of the United Kingdom, or other similar-sized countries in Europe, our standards in, say, education have regressed. That is not to say they have not improved (although in some instances they have indeed worsened), but that relative to what has been achieved elsewhere under similar circumstances Scotland has fallen back from where it was.

A comparative study of Scotland’s healthcare by ThinkScotland confirms that our NHS, for all that we appreciate what it does, has not kept pace with improvements in other countries or the rest of the UK. Audit Scotland conducts a comprehensive annual report on the NHS in Scotland which, at 29 per cent of all spending, accounts for the largest item of expenditure by the Scottish Government. This is a useful exercise insofar as it creates pressure to improve management of the NHS within its existing institutional and financial framework. But, again, the problem is that it looks at Scottish affairs in isolation from what is going on in the rest of the world.

Rather than rely on Scottish studies that look inwardly we should examine international studies that compare Scotland to other healthcare jurisdictions. OECD data shows that the UK as a whole has one of the worst records when it comes to mortality and treating key diseases like cancer and stroke. Meanwhile two detailed studies, both of which consider Scotland separately from the rest of the UK, do not make for good reading, placing Scotland not just behind other similar countries, but no better (or slightly worse) than England, despite much higher levels of funding.

The most comprehensive comparative study of European healthcare is by the Swedish Health Consumer Powerhouse. The 2013 index listed Scotland in its own right for the first time, allowing a comprehensive comparison of Scotland’s NHS with other European services. While Scotland ranks mid-table at 13 out of 35, the majority of those countries behind us are former communist east European states that have a great deal of catching up to do. In western Europe, only Ireland, Italy, Portugal, and Spain perform worse than Scotland, while the Netherlands, Belgium, Switzerland, France, Germany and Scandinavian countries all perform significantly better.

A study by the Health Foundation and Nuffield Trust, published in April 2014, confirms that while performance is broadly similar across the UK, mortality rates that are responsive to healthcare are still a little better in England than the rest of the UK, despite lower overall funding. The truth is Scotland’s NHS is performing poorly compared with the high standard of healthcare available elsewhere. 

Scottish politicians talk about addressing social inequalities and protecting the NHS yet fail to answer the most basic questions: why are our hospitals so much worse than in Holland or Denmark? What can we learn from our European neighbours? Why has so little been done to reform healthcare by the Scottish Government? Why has so much money been wasted?  If only we addressed Scotland’s chronic health issues – those same inequalities would lessen and poverty itself could be alleviated, bringing benefits to the whole of society and the economy. 

Holyrood already has the powers to address education and health reform but has preferred to avoid confronting the real challenges for fear of offending the voters – a cowardly approach the SNP’s latest legislative programme intends to continue.  It is time for the Parliament to toughen up and stop blaming others who, by international standards, are doing much better.

This article was first published in the The Sunday Times on 30th November 2014


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