THERE used to be a certain smugness in Scotland about the NHS.
While tales of degradation, incompetence and tragedy seemed almost commonplace in an English health system clearly creaking at the seams, the Scottish NHS appeared exemplary by comparison. In recent years, however, that distinction has often appeared less clear-cut.
Health spending in cash terms has more than doubled across the UK in the past decade, but the improvements this money has bought have been unevenly felt. In 2012, a National Audit Office report comparing health care delivery across the four constituent parts of the UK found Scotland lagging behind England in hospital waiting times. This was despite more money being spent on Scottish hospitals than their English equivalents. In a number of more recent health statistics, the picture painted of the health service in Scotland is of a declining standard of care.
An Audit Scotland investigation this month revealed that the number of patients waiting too long in accident and emergency departments had nearly tripled in five years, with 104,000 people waiting beyond the four-hour target in 2012-13, compared with about 36,000 in 2008-9. Shortly afterwards, a review was launched into A&E care in Aberdeen hospitals after concerns about the quality and effectiveness of emergency care there. Also this month came the report revealing that the majority of Scotland’s health boards had failed to meet the national target for urgent cancer treatment. The bad news culminated last week when Brian Keighley, chair of the British Medical Association Scotland, described the NHS north of the Border as “a car crash”, adding out-of-hours care as well as bed-blocking, cleanliness and poor food in hospitals to the lengthening list of problems. On top of all this comes our front page report today on the precarious state of GP services in Scotland, and the possibility that when you phone your local doctor’s surgery you will instead be put through to a call centre. So what is going wrong with our NHS, and what needs to be done to fix it?
There are, of course, some very practical reasons why our NHS is under pressure. One of these is the simple fact that more and more people want to see their doctor, or feel in need of A&E treatment. Perfectly demonstrating the circularity of so many problems in the NHS, many of those in A&E waiting rooms are there because they have found it hard to get hold of their GP. These are problems that require innovative solutions – some of them clinical, but many of them administrative. In England, rapid improvements in many aspects of patient care have been achieved by bringing in private sector companies to provide specialist services that treat patients quicker, more cheaply, and with better clinical outcomes. In Scotland, due to the ideological objection of the SNP, use of such private firms is discouraged, if not banned. What the current Scottish administration finds it hard to grasp is that private contractors can be used to supplement the NHS without recourse to the wholesale introduction of the market into health care, which is the source of many of the NHS’s difficulties in England.
Health secretary Alex Neil is already a minister under pressure. He recently survived calls for his resignation over his intervention to halt the closure of an NHS facility in his constituency – Neil told parliament he had divested himself of responsibility for the decision, whereas in fact he had instructed the local health board to save the facility from the axe. His survival may be more down to Alex Salmond’s unwillingness to lose a cabinet minister during the referendum campaign than the merits of the case. Whatever the reason, he is now a minister who has much to prove if he is to persuade Scottish voters the NHS is safe in his hands.
Celebrities a force to be reckoned with
AND so another celebrity makes her view known on the independence referendum. This time, as we report today, it is Scottish actor Rose Leslie, one of the stars of the TV show Game Of Thrones. To say this programme is a hit is a lamentable understatement. It is a global phenomenon with millions of fans around the world. It is one of those shows that tends to divide opinion – either you have never seen it because the dungeons-and-dragons thing isn’t for you, or you are obsessed with it.
If you are in the former camp, the fact that Leslie is a No voter – and a pretty trenchant one at that – will mean little to you. If you are in the latter camp, her declaration in the referendum campaign can be the cue for an anoraky conversation with fellow fans about how closely the bloodthirsty and power-crazed storylines of Game Of Thrones reflect Scotland’s own epic battle for constitutional supremacy.
But will fans of Game Of Thrones now be swayed to vote No in the referendum on September 18? The conventional political wisdom is no, they won’t – voters are far more sophisticated than to allow themselves to be swayed on such an important decision for their country by the sprinkling of a pinch of celebrity fairy-dust. The truth, however, is perhaps a little more subtle. Politicians’ stock is at an all-time low, and the competing promises of the rival sides in the referendum are regarded by many voters as equally unreliable. What may ultimately matter more is who the voters think is metaphorically accompanying them as they enter the voting booth. There are compelling voices from the worlds of music, books, acting and entertainment arguing on each side of the referendum campaign. Some – such as novelist William McIlvanney, who is arguing for independence – are serious intellectual figures who can be regarded as touchstones of popular opinion.
Some – such as UK supporters David Bowie and JK Rowling – are cultural icons who are part of the very fabric of many people’s lives. Celebrity endorsements will play more of a role than politicians would care to admit, because voters will want to identify with people they feel an affinity with. There will be many factors influencing how people vote, and like it or not this will be one of them.