Leader: Holyrood must take decisions soon or pain will be worse

Published on Thursday 9 September 2010 15:01

Eighteen months from the alarm bells first sounding on government debt and five months from the warning of painful budget reduction from the Westminster coalition, the pace of preparation in Scotland for measures to ameliorate these cuts can safely be described as glacial.

The SNP administration seems to be in no rush. It has the strongest political reason to delay the whole unpalatable business, preferably beyond the Holyrood elections next May.

Local authorities, fearful of the fate that awaits them, and reluctant to undertake structural reform that could yield substantial savings, reach for the escape door, warning that they will break the concordat and raise council tax - a prospect that can only fill already financially stretched council tax payers with anger and apprehension. In this intensifying stand-off, the players are desperate to avoid first-mover disadvantage for fear of the adverse political consequence that would follow. Delay thus seems the least worst option. Unfortunately, every week of delay loses time for other options to be explored and intensifies the risk of rushed and ill-considered reductions that could hit the poor hardest.

It is against this backcloth that the proposals of Professor David Bell, adviser to the parliament's finance committee, should be seen.

As an alternative to reintroducing charges for personal care - few now prefix this with the gratuitously misleading adjective "free" - he suggests the extension of charging in the NHS to help defray the "bed and board" expenses of a stay in hospital. Well anticipating the knee-jerk protest that would immediately greet such a proposal, Prof Bell cites the example of Sweden, so long held up as a model for Scotland. It is less well known than it should be that user charges provide around 3 per cent of the country's health budget - which would be the equivalent of 300 million to Scotland's health budget. Were Scotland to follow Sweden's lead, patients would pay 15 per doctor visit and 15 per hospital visit, capped at around 75 for any single year.

The Holyrood parliament, so used to spending to the hilt, now has to face difficult choices. In this particular case, the choice is not, as some would have it, between health charges and no health charges, but between no health charges and significantly more severe spending cuts and job losses elsewhere. Exactly the same principle applies with Scottish Water - a reconfiguration along the lines of Welsh Water that could yield significant real savings for the administration or tougher spending cuts. In ruling this out, together with an insistence on ring-fencing the NHS and personal care, the administration is setting the country up for severe reductions in government and local council services. There is now an urgent need for serious and mature debate in Holyrood on the real choices that we face and to end the simplistic "ya boo" resistance to proposals that could spare Scotland the worst of the pain.