Yet we remain stuck in the same mire of under-achievement. The heroic efforts of those who work in the service remained unmatched by the rhetoric of politicians more interested in protecting their own reputations than in driving through the changes which are required.
Ever since 1948, there has been an exceptionally strong Scottish commitment to the NHS and its underpinning values. Yet according to the latest Scottish Social Attitudes survey, just 22 per cent are satisfied with our NHS, the lowest figure since records began.
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At the same time, admissions to private health services in Scotland has increased by 55 per cent since 2019 – not just by those who can afford them but by many who really can’t but feel they somehow must, because the alternative waiting times are so dire.
Anyone who seeks to dismiss McKirdy’s report because it was commissioned by the Scottish Labour Party is either a knave or a fool. Maybe they should try reading it because every line carries the ring of truth, which will have to be addressed or ignored by whoever runs Holyrood after next May.
McKirdy, with 40 years experience of the front-line, ending up as President of the Royal Society of Physicians and Surgeons, knows Scotland’s NHS like the back of his hand. When he says that the service’s founding principles have become “strained and frayed” with the real threat of “entrenching a two-tier system”, he deserves to be listened to, across political lines.
For the past 18 years, a steady procession of Scottish Health Ministers – the familiar repertory company of Sturgeon, Yousaf, Matheson et al – have relied on media announcements rather than addressing any detailed critique or structural need for change. According to McKirdy, “130 major strategies have been published – roughly one every seven weeks”.
In contrast, even the most basic practical questions go unanswered. Why does it now take “a median wait” of 22.5 minutes for NHS24 to respond to a call? Why will it take till 2030 to roll out a Scottish primary care digital app? Why does Scotland need so many boards and bureaucracies to run a medium-sized health service?
If any minister was put in front of a microphone and forensically examined on these questions or a hundred more, they would be out of their depth within 30 seconds, after assuring us that “corners have been turned” or “progress is being made”, whatever statistics or lived experience might say to the contrary.
That’s before we get to the delivery of services but a main theme of the McKirdy report is that the two are inextricably linked. If the framework and management are wrong, and the political vison is non-existent, then the outcomes will never deliver advances that are both possible and necessary.
“The NHS in Scotland”, he writes, “has failed to keep pace and adapt. It is still trying to deliver the same services under an outdated model of care. The result is a short-term, fire-fighting approach that is not delivering the long-term improvements that Scotland needs … Reforms have been driven more by the desire to be seen to be doing something in response to specific problems, rather than connected to a wider vision for a modern delivery of care”.
In that environment, money is not the answer to everything, even when there is plenty of it. Indeed, the central enigma which McKirdy identifies is that while more is being spent and staff numbers are increasing, outcomes remain resistant to improvement. That takes us back to structures, management and governance: the factors which politicians determine.
“In recent years”, writes McKirdy, “the Scottish Government has satisfied itself that it is providing resource, without adequately asking whether funding is going to the correct places. The result is that while spending has increased, outcomes for patients have not improved to a comparable extent”.
Not only does Scotland have 14 Health Boards, there are also 31 integration boards and numerous other quangos, all under tight Scottish Government control. “This complex structure”, writes McKirdy, “means reforms and improvements are difficult to roll out at scale or pace, while accountability and transparency are made easier to avoid”. Every NHS head will nod in support of these words.
McKirdy also dispenses with the claim that it is all down to Covid. “The challenges in the NHS were not caused by the Covid-19 pandemic”, he states emphatically. “The inability of the system to deliver was evident before 2020 across a number of performance measures … Unsurprisingly, a health and care system that was unable to meet demand prior to the pandemic has proven incapable of recovering”.
What are the politics of all this? It is indisputable that the SNP have been in government for 18 years during which satisfaction with the NHS has gone from its highest ever levels to the lowest. That alone suggests that they might be the last people one should look to for the vision or competence to fix it.
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Ironically, the degree of failure is compounded by the fact that Scotland avoided the disastrous Lansley reforms of 2012 which caused so much disruption within the NHS in England. In contrast, the SNP has had a continuous period to make progress on reform within a society which is hugely supportive of the NHS. It only had to understand or prioritise the need to do so.
Yet the outcome has been an unreformed system, a burnt-out workforce and the lowest satisfaction ratings on record. We really did have the opportunity to do things so much better than in England, which is the only measurement that enthuses our political leaders. But despite all that, we ended up in pretty much the same place.
The difference is that in England now, positive change really is happening and the extra money is being spent to good effect. Will Scotland make the same choice – or is it prepared to be stuck with more of what has taken us to where we are?
Brian Wilson is a former Labour Party politician. He was MP for Cunninghame North from 1987 until 2005 and served as Energy Minister from 1997 to 2003