The names of Graeme Roy and Stephen Boyle won’t ring many, if any, bells with the average Scottish voter. They are, however, two of the most significant and consequential figures in public life.
Roy and Boyle are the people’s brain and voice when it comes to keeping watch over the devolved state’s performance, the former as head of the Scottish Fiscal Commission, the latter as Auditor General.
Over the past few years, both have produced a series of sharp-toothed reports examining the outcomes of government policy, the domestic and external pressures being brought to bear on the nation, and its prospects. They have done so ruthlessly, banging on dials, scouring the data and issuing ever doomier prognostications. Roy and Boyle have fearlessly told the truth about what is going on and what is going wrong – and they have been unafraid to point out where the problems are, all too often, self-inflicted.
In this, they have only done their jobs, but they have exposed the truth at a time when too many others – including Holyrood’s largely woeful committees – have shrunk away from confronting the mighty SNP machine. With each passing Fiscal Commission or Audit Scotland publication, the warning lights have flashed ever redder as the underperformance of public services and the threats to Scotland’s current and future prosperity have grown. The authors may be mild-mannered individuals of a wonkish persuasion, but if these reports could speak they would produce one long scream of alarm.
Roy returned to the fray this week with his commission’s latest work, which examines the risks to devolved spending and funding over the next 50 years. The new data produced on demographic change and the growing burden of spending on the NHS and wider health issues should keep ministers awake at night.
The Scottish population is now projected to grow over the next 25 years, due to increased immigration (it was previously projected to fall). But over that same period there is an expected 26 per cent increase in the number of people aged 75 to 84, and a 95 per cent increase in the number aged 85 and over. The working-age population – the bit between 16 and 64 that produces the bulk of government revenues – will fall. This means fewer productive people will have to pay more to support the rest. Scotland’s population as a share of the UK’s is expected to drop too, which, in the event of further austerity at Westminster, will have consequences for Holyrood’s funding and spending power.
There is no let-up from the gloom. Life expectancy is higher in England than in Scotland and will likely stay that way. Indeed, healthy life expectancy in Scotland has declined over the past decade. Health inequalities are wider, too – the most recent figures show a horrific 12-year difference in average life expectancy between the most and least deprived areas in Scotland.
The Fiscal Commission produced a worst-case scenario, based on the gap between Scottish and overall UK life expectancy increasing, spending on health failing to improve in line with life expectancy, reductions in labour market participation, and an increased share of the population receiving disability payments. “The worse health scenario could be considered more likely,” it stated, which would mean at its peak an annual budget gap of 11 per cent, equivalent to £14bn. That is quite a chunk of a tartan treasury which currently amounts to £60bn a year.
The impact of these changes and stresses on health spending will be profound. By 2029-30, health is expected to take up 34 per cent of the annual budget, and grow to 47 per cent in 2074-75. An ageing population with long-term health problems will require more from the NHS and, obviously, from social care. Technological improvements could lead to higher rather than lower costs as new medicines and treatments come onstream.
Now, these problems are not unique to Scotland. Countries across the developed world have ageing populations, which bring with them similar challenges. But it seems fair to say that our nation’s politicians as yet show little sign of standing up before the scale of what’s required.
The Scottish government has begun a process of streamlining the public sector – reducing its property footprint, cutting back quangos, attempting to cut procurement costs – but realistically this won’t even touch the sides of what’s required. It seems unlikely that the ideology of the SNP, or the nature of its political support, will ever allow it to do so.
But Scottish Labour is a disappointment on this front, too. So far, the policies it has produced amount to not much more than mild tinkering, when major surgery is clearly required. On both sides of the aisle, therefore, there is a lack of courage to confront economic reality or to have a mature conversation with an electorate that surely knows all too well that the existing settlement cannot endure. Whoever wins next May, it seems certain that the provision of “free stuff”, of universalism wherever an opportunity presents itself, will continue, and the really hard conversations will be avoided.
On health, the Fiscal Commission points out – as so many have for so many years – that a shift from treating illness to preventing it is necessary if costs are to be managed. But who will be brave enough to remove money from the NHS and spend it instead on maintaining a healthier population? How would either party respond if their opponents tried to do so? It’s not hard to guess the answers to these questions.
On social care, a present and future crisis exacerbated by that ageing population, where will the funding come from to support its urgent expansion? Cuts elsewhere? Higher taxes? New taxes? Social insurance? The evasive will-o’-the-wisp of strong economic growth?
Behind the scenes, leaders of all persuasions are well aware that Scotland is heading for a cliff edge. And it’s true that the politics of steering us away from that edge are fiendishly difficult. But that is the nature and demand of effective leadership. They have been told, repeatedly, by Roy, Boyle and others, that change must happen. Frankly, Scotland needs someone with the shoulders and the determination of a Thatcher or a Blair, who will tell it like it is. Tinkering and squabbling, which is what we have instead, won’t cut it.
Content from our partners
Related
