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  1. The Staggers
5 April 2023

The Scottish NHS deserves far better than Humza Yousaf’s tired plans

The First Minister’s early moves suggest a preference for political fudge and risk avoidance.

By Chris Deerin

Another day, another damning statistic from the Scottish NHS. This time about cancer patients: a third were not treated within the two-month target in the final quarter of last year.

The figure – only 71.7 per cent were seen in time – marks a decline on the previous three months and is 12 percentage points lower than in the final quarter of 2019, before the Covid pandemic began.

It is just one more grim data point on an NHS dashboard that has been covered in flashing red lights for some time. SNP ministers like to point out that the health service in England is also struggling, but what of it? A Scottish government’s job is to fix things north of the border.

The problems include the sick not being treated on time, huge queues at A&E, bed blocking, a care crisis, and recruitment – there are more than 6,000 vacancies for nurses and midwives. The system is at breaking point, though some would argue it is already broken.

[See also: Why the battle for the Union is far from over]

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This winter’s crisis seems to have snapped the patience of clinicians. Many of the public complaints and demands for action have come from within the NHS, rather than being led by opposition politicians. In recent months I’ve spoken to a wide array of health workers – smart, reform-minded consultants, GPs, nurses and senior people at trade unions – and the conversations have been uniformly gloomy. They have had enough of sticking-plaster solutions, neglect of immediate and long-term problems, and their sector being treated as a political football between the parties at Holyrood. They are worried that without fundamental change the NHS will simply fall over within a decade.

Humza Yousaf, the First Minister, was approached late last year while he was health secretary and asked to set up a “national conversation” on health reform, along the lines of the one currently taking place on education. His petitioners were rebuffed – Nicola Sturgeon’s government had too much else to worry about. Since then the system has only declined further.

I’m not sure that such an approach is the right one, anyway. The very phrase “national conversation” reeks of fudge, political control and risk avoidance. That’s the way the education review is heading, with ministers effectively having decided the parameters of what’s acceptable before the process is completed, or was even started. The last thing they want is bold ideas that will challenge their ideology and be difficult to implement.

The NHS, like schools, deserves better. The world in which it operates has changed beyond recognition since its creation in 1948. We are not so far off celebrating its centenary, but if things are allowed to continue as they are, will there be anything to celebrate? The challenges of continuing to deliver comprehensive healthcare free at the point of use are huge: the population is rapidly ageing, meaning people are living longer and therefore being sicker for longer. The number of people active in the Scottish workforce is projected to shrink, so that tax revenues are unlikely to grow with increased demand on the NHS budget. Sturgeon’s plans for a new National Care Service are such a mess that each of the three candidates to replace her promised to look at them again.

[See also: Scotland needs its own Rishi Sunak]

Something more ambitious is needed. If Yousaf is looking for a big, positive announcement that shows he is serious about governing and that he might yet confound his critics, he should set up an independent review into the short, medium and long term of the NHS. Why are there such gaping recruitment gaps and how do we close them? What role can technology play in keeping people healthier and saving money? Do we need more centralised, specialist centres to ensure specialists can provide world-class operations and treatment, and do ministers have the guts to close local services to make this happen? How do we break down silos within the system? And what is the conversation that needs to be had with the public so that they understand the limitations of a rationed system that relies on a finite state budget?

Yousaf could do worse than appoint Paul Gray, the clear-minded, shibboleth-challenging former chief executive of NHS Scotland, to chair such an inquiry. The membership should include the smartest clinical minds, who understand what the necessary changes should look like. A few hard-headed figures from the business community wouldn’t be a bad idea, either. 

There is a role for politicians, too, but it should at first be relatively minor. A carefully selected MSP from each party might join the inquiry to ensure they are invested in its conclusions and reduce the chances of self-interested politicking. All parties should commit to implementing the findings.

Britain has proved particularly bad at long-term planning for its national infrastructure, and Scotland itself is no different. The polarisation of our politics serves to block collaboration, even when it is in the national interest. Vital changes are avoided or fall victim to the electoral cycle.

A first minister of stature, and who genuinely has the interests of all Scots at heart, would show he understands that the health system is too important to be allowed to rot. Let the experts decide, and then get on with it so that by 2048 we still have a National Health Service worthy of the name.

[See also: Can Humza Yousaf put the broken SNP back together?]

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