Time for Change?

NHS Scotland

Iain Gray MSP argues that steady as she goes is no longer an option for NHS Scotland.

Someone said that there are two kinds of politicians; those who fail, and those who get out in time. Many are now asking if Nicola Sturgeon is one who got out of the Health portfolio in the nick of time?

When I was a junior health minister, Sam Galbraith, MSP and surgeon told me, “there is a health crisis in the newspapers every day – don’t worry about it”. That was not true for much of Nicola Sturgeon’s tenure in Health. It is now though, and NHS crises abound.

An A&E in Fife repeatedly closed due to staff shortages. Hundreds of A&E patients across Scotland waiting more than 12 hours to be seen. Doctors claiming the children’s heart unit at Yorkhill is “unsafe”. Four patients every week “starving to death” in our hospitals, according to one front page. The Health Inspectorate found dirty wards in Inverness, a lack of training in the ambulance service and “neglect” of the elderly in Edinburgh’s Royal Infirmary. Their damning report on Ninewells was “not published”. A Royal College is warning that a Mid Staffs type scandal could happen here.

So, has Alex Neil been left to clean up Nicola Sturgeon’s mess? Two reports from Audit Scotland provide some clues. The first was a summary of the NHS’s financial position. On the face of it all NHS Boards met their financial targets. But the auditor general pointed out that this had been achieved in ways which are unsustainable. Many boards had made savings which were non-recurring. Others “borrowed” money from the Scottish government to balance the books. Together they had simply shelved £1 billion of maintenance, some of that critical to patient care. Overall the Auditor general pointed out that NHS budgets had declined in real terms, and will decline further in years to come. NHS staffing is at its lowest since 2006, nurse and midwife numbers at their lowest levels since 2005. A total of 5,000 posts have gone in the past three years. Capacity has plummeted too, with 1,000 fewer beds since Sturgeon became health secretary, with the Royal College of Physicians saying patients’ lives are at risk. The picture painted was of a service only just holding the lid on. The Auditor General called her report an “amber warning”.

Then came Audit Scotland’s waiting times report. They could not prove waiting lists had been systematically falsified except in Lothian, but neither could they explain why numbers of “socially unavailable” patients had soared until the moment Lothian was rumbled, at which point other boards suddenly found they had far fewer unavailable patients after all. Whatever else was going on, Audit Scotland concluded that targets had been prioritised over patient care. In Lothian at least that meant staff being bullied and intimidated into doing what counted rather than what mattered.

Sturgeon was well regarded in the NHS. She took care to communicate with, and acknowledge staff. She was a conservative Minister, avoiding reform and the challenge to staff interests this often involves. Yet she also set ever shorter waiting time targets for purely political purposes without consideration of how they could be achieved, and at the same time cut the staff who had to deliver them. Her no compulsory redundancy policy was laudable, but without reform it created random shortages and left staff being asked to do more of the same with fewer colleagues.

Fifteen years ago patients were waiting two years for treatment, and cutting waiting times was the right priority. In 2013 it cannot be the sole measure of success in our NHS. Labour Health Ministers made mistakes sometimes, but they were willing to reform to improve outcomes. We must start thinking about the NHS we want again, and start reforming again. Care of the elderly should be comprehensively integrated in a National Care Service, neither NHS nor local authority. Most non-territorial health boards should go, releasing funds to the front line. Highly technical surgery has to be centralised in centres of excellence to maintain skills and the best possible outcomes. Conversely, routine procedures, rehabilitation and palliative care should be delivered in smaller local hospitals. GPs should take core responsibility for these units – even if their contract has to be changed to allow it. We should increase the power of Boards to distribute GPs so that there are more where we need them most – in areas of deprivation where patients have multiple health problems.

That is no more than base camp for addressing health inequalities; supposedly Nicola Sturgeon’s overriding priority in health. In fact a third Audit Scotland report says that these inequalities got worse under her stewardship, as they have for decades. We need to change the NHS, and not just the cabinet secretary or the IT system. Steady as she goes is no longer an option for staff or patients.

Iain Gray is the MSP for East Lothian and is Convenor of the Scottish Parliament Public Audit Committee

From Healthier Scotland: the Journal