‘DON’T worry, there is an NHS crisis in the papers every day,’ a surgeon and former MSP said 12 years ago. So what is the state of the service today, asks Iain Gray, and are our lives in good hands?
Last week Alex Salmond apologised for claiming during First Minister’s Questions that college funding had increased, when in fact it has been cut. But the week before, he had done the same thing with NHS funding, saying “we have maintained real-terms spending in the NHS”. He said it three times. But it is not true.
One day earlier, the Auditor General for Scotland, Caroline Gardner, presented her report on NHS finances to the parliament’s audit committee. Paragraph two says: “Although the overall health budget has continued to increase in cash terms, it has been decreasing in real terms since 2009-10 and is projected to decrease further in real terms…”
So the First Minister was not telling the truth about NHS budgets, but what is the truth about the health of our NHS? After all, this is the department recently left by Nicola Sturgeon, devolution’s longest-serving health minister, who received widespread praise for her stewardship.
When I was deputy health minister under Donald Dewar, my Labour MSP colleague and renowned surgeon Sam Galbraith advised me: “Don’t worry, there is an NHS crisis in the papers every day in life.”
It seemed true then, but not for most of Sturgeon’s watch.
Now, though, Sam seems right again. The chief executive of Lothian resigned after being caught fiddling the waiting-time figures. An A&E in Fife has repeatedly closed due to staff shortages, as has a children’s ward in Livingston. Hundreds of A&E patients across Scotland are waiting more than 12 hours to be seen. NHS Lothian is reduced to sending people abroad for operations.
Doctors say the children’s heart unit at Yorkhill is “unsafe”. Four patients every week “starve to death” in our hospitals, according to one front page. The Health Inspectorate uncovered dirty wards in Inverness, a lack of training in the ambulance service and “neglect” of the elderly in Edinburgh’s Royal Infirmary. The ombudsman has upheld record complaints against the NHS. There was another apology from Alex Salmond, too, to a patient denied a blanket in hospital.
So did new health secretary Alex Neil get an NHS in good order, or a poisoned chalice? The Auditor General’s report contains clues. She called it an “amber warning”, pointing to NHS boards balancing their books with short-term measures, such as “borrowing” from government and counting on high-risk, non-recurring savings to live year to year. A total of £1 billion worth of maintenance has been left undone. Not one major capital project was started last year.
The NHS depicted is only just holding together, hence the outbreak of “crisis” stories.
Sturgeon was very good at handling problems in the NHS. I saw too many Labour health ministers, when things went wrong, making NHS managers’ excuses for them, until they seemed part of the problem. Sturgeon always acted decisively and made sure she was on the side of the patient, not the bureaucracy. Thus she escaped blame, even in the Lothian waiting-times scandal, and problems were managed without escalating. Now the underlying impact of real-terms budget cuts has left too many crisis plates spinning, and “Galbraith’s law” is back.
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.
Delays to projects like the new Sick Kids hopital in Edinburgh mean that care is delivered in facilities growing more obsolete every day.
Yet in spite of these cuts, Sturgeon was well regarded in the NHS. One reason was the care that she took to communicate and engage with staff, directly and through other means, such as regular e-mails. But she was also a conservative minister, avoiding reforms that upset and challenge professional interests.
So, of all the recent NHS stories, perhaps the most significant was a Royal College of Surgeons report that we lag the developed world in trauma care. This is because we have not focused specialist services, like trauma treatment, in centres of excellence. These improve survival rates, because surgeons carry out highly technical procedures regularly, maximising their expertise.
Labour’s three NHS ministers were all reformers. Andy Kerr started to implement the radical report by Dr David Kerr, including centres of excellence. Malcolm Chisholm commissioned that report and introduced free personal care. Susan Deacon fairly burned with reforming zeal, but she failed to take officials with her, including the head of the NHS, who left. A loss, he was later described (in an obituary) as the “best public-service manager of his generation”.
Nicola Sturgeon’s only major, reluctant, reform was health and social care integration, emerging as a timid project, maintaining divided accountability for care and allowing vested interests to protect their institutional power through bureaucratic “frameworks”.
In any enterprise, “not rocking the boat” becomes drift, and the Scottish Government’s policy of no compulsory redundancies is laudable, but unhelpful. Posts have been cut randomly, leaving gaps that cannot be filled.
We must heed the Auditor General’s warning, and start talking about the NHS we want again. Step one is to admit that budgets are going down, staff levels are being cut, and so are beds. Step two is to put reform on the agenda again. Care of the elderly should be comprehensively integrated in a National Care Service, neither NHS nor local authority run. Most non-territorial health boards should go, to release funds to the front line.
But we cannot dodge planned reform of that front line any longer. That idea scares the SNP, because they demonised Andy Kerr for reforms like centralising Lanarkshire A&E services. They know that when Deacon put the paediatric heart unit in Glasgow, her local paper accused her of “stabbing Edinburgh in the heart”.
In East Lothian, the recent closure of a minor injuries clinic in Dunbar’s Belhaven Hospital is very unpopular. But I have to accept that staff were dealing with 120 patients a year, and they could not keep their skills levels up. Yet my small local hospitals, in Dunbar and North Berwick, and the larger one in Haddington are part of the answer. They allow patients who have been to Edinburgh or Glasgow for surgery to recuperate close to home and family, without being lost in the system. They provide end-of-life care in patients’ own communities. They are the NHS on a human scale.
This is the way back into the NHS reform debate. Highly technical, specialised care does need to be delivered in centres of excellence. But people will only accept that if more routine care, tests and outpatient services are delivered more locally. If we start with strengthening, not cutting localism, then we can win the argument for centralisation where appropriate.
My local hospitals should be regarded as a model, not an outdated anomaly. That will not happen if reform is allowed to happen by default, driven only by declining budgets. It certainly will not happen unless the new health secretary starts talking about planned reform of the NHS, rather than pretending to protect a non-existent status quo.
Nicola Sturgeon’s “steady as she goes” NHS strategy will not work much longer.
• Iain Gray is Labour MSP for East Lothian and was deputy minister for health and community care between May 1999 and November 2000.