It's time the NHS took its medicine

Published on Tuesday 8 July 2008 22:16

POLITICIANS are not used to receiving ovations from the medical profession. A slow hand-clap is more the norm. So the health secretary, Nicola Sturgeon, must feel especially privileged after her warm reception from the annual meeting of the British Medical Association, which this year is taking place in Edinburgh.

What Ms Sturgeon had to say to the BMA conference was doubtless music to the ears of Britain's GPs. She denounced government moves in England to introduce more competition and commercialisation into the NHS, and promised that in Scotland the SNP would legislate to ensure there was no privatisation of GP services "by the back door".

Curiously, Ms Sturgeon did not make reference to a recent report by Audit Scotland, the official watchdog, which exposed a 160 million overspend in the NHS Scotland budget for primary care services arising from a sloppily negotiated contract with the BMA. Or that despite a massive increase in GP salaries, Audit Scotland could find only a modest improvement in primary health care provision.

This is not to criticise Scotland's hard-working GPs. Rather, it is to point out that the NHS has seen its funding doubled in the past decade without a corresponding improvement in overall performance. As for the future, the NHS is unlikely to see such largesse for a long time, yet the cost of providing healthcare continues to escalate. All of which suggests that finding more efficient ways of running the NHS should be at the top of the political agenda at Holyrood as well as Westminster. Unfortunately, Ms Sturgeon seems more at home with taking ideological stances rather than solving these pressing problems.

In England, after some initial delay, Gordon Brown has returned to the agenda of the Blair years and is pursuing greater choice and competition within the NHS, in order to encourage a better use of scarce resources. This model has led to quicker progress on reducing waiting times as compared to Scotland. It is possible to argue that this is at the expense of the public-service ethos, but it seems to work.

The next stage of reform in England involves the creation of a network of "polyclinics" – NHS-run primary care centres which are open to anyone off the street. These are meant to supplement GP services, but it is understandable that the BMA sees them as a threat. Patients trying to find a GP after hours may consider them a boon.

No-one is suggesting that NHS Scotland slavishly follows the English model or that there are not good things to be emulated in the health service north of the Border. For instance, the SNP has reversed the closing of local A&E units, which has proved very popular. The charge, rather, is that Ms Sturgeon has no convincing plan for how to improve NHS efficiency and patient care in a time of flat public spending. Platitudes about the NHS "ethos" will not pay the bills or reduce waiting times.