Labour believes it can convince voters the SNP – and especially the First Minister – should carry the can for an NHS in crisis
PROFESSOR Malcolm MacLeod is pausing for a very quick breather before an afternoon clinic for patients who have just had a mini stroke. His job is to see them as quickly as possible. The sooner the patients receive treatment, the less likely they are to suffer a more severe episode that could result in serious disability.
As he stands in one of the most modern hospitals in Europe, MacLeod waxes lyrical about the astonishing medical advances that ensure so many stroke patients make a full recovery.
But despite the up-to-date facilities and the remarkable medication and techniques at his disposal, MacLeod is deeply concerned about the state of the NHS.
“It is fair to say that this month the NHS is in a state of crisis. Every year we get busier and busier. But it is always worse at this time of year,” said MacLeod, a consultant at the Forth Valley Royal Hospital in Larbert.
According to MacLeod, the NHS in Scotland is suffering from an acute shortage of beds. Doctors are being pulled away from their normal duties to cope with the influx of elderly patients arriving at hospital laid low by winter bugs. Often confused and disorientated, their existing medical conditions are complicated by the ravages of winter and its annual onslaught of viruses.
Clinicians are running around “like blue-arsed flies” doing their utmost to keep on top of their rapidly expanding case loads. Private contractors are being brought in to meet waiting times targets, while cash shortages hamper the recruitment of consultants. Scotland’s hospitals are straining at the seams.
Doctors and nurses desperately want winter to pass. It is only then that things will begin to calm down. Then they can start to contemplate sorting out some of the minor administrative cock-ups that inevitably arise when a system is under severe stress. They may even find a little time to think about planning for the next crisis.
SCOTSMAN TABLET AND MOBILE APPS
As winter fades away with the coming of the spring, the political heat will pick up dramatically as the general election looms.
The winter crisis will be over. But the political argy-bargy over the state of the NHS will be at the heart of the campaign.
As MacLeod’s description of a creaking system suggests, the NHS is in need of radical surgery. The political parties are only too aware of this and over the next few weeks they will set out how they intend to take up the never-ending challenge of NHS reform.
This weekend, the newly installed Scottish Labour leader, Jim Murphy, signals that he intends to fight the general election in the hospitals, wards, intensive care units, old folks homes and doctors’ surgeries that make up Scotland’s NHS.
Like all politicians, Murphy knows that every member of the electorate is a patient or potential patient. The NHS touches everybody. Votes, and indeed elections, can be won and lost over the health service.
As far as Murphy is concerned, he strongly believes there are votes for Labour in attacking the SNP’s record on health.
Over the next few weeks, Scottish Labour will focus on the SNP’s health record, because it sees it as a weakness for First Minister Nicola Sturgeon. It is a line of attack that Murphy’s strategists believe will be particularly effective.
From 2007 until 2012, Sturgeon was Alex Salmond’s health secretary. Her tenure ended when she was succeeded by Alex Neil and she was moved to lead the Scottish Government’s referendum strategy.
“Nationalists know it is a potential weak point – particularly for the First Minister, given her stewardship of the NHS. She knows where the bodies are buried,” remarked one Labour strategist, suggesting that health decisions made under Sturgeon’s watch could come back to haunt the SNP.
“She is, after all, the politician who gave up on health in order to fight the referendum.”
Although regarded as a highly competent health secretary who was liked by health professionals, it has been suggested that a few tricky issues were put on the back-burner during her tenure.
There is concern that Sturgeon was too preoccupied with the SNP’s populist agenda of universalism that saw the Scottish Government commit itself to free personal care for the elderly and roll out free prescriptions.
This was done while failing to tackle the crucial challenge of how to use finite resources to fund a complex and indescribably expensive behemoth, which is having to cope with an ever increasing demand from patients who are living longer than ever before.
Although Murphy has also committed himself to the costly principle of universalism, the Labour leader believes that the NHS will be a fruitful area for him as May comes nearer.
Heading towards a UK election, Murphy is banking on his idea that using Barnett consequentials from Labour’s Mansion Tax will fund his NHS election promises, such as his promise to provide 1,000 new nurses.
For Murphy, concentrating on the Mansion Tax has two important attractions. Not only does it offer an explanation for how he can afford his health pledges, but it also turns Scottish NHS funding into a relevant issue going into a Westminster election.
By linking the Scottish health service to a UK tax, Murphy can argue that a Labour government can make a difference to Scottish healthcare, despite the issue being almost entirely devolved to Holyrood.
Scotland’s separate health service has meant it has been sheltered from UK health reforms such as the controversial Health and Social Care Act 2012, which has led to fears of heavier private sector involvement in the NHS south of the Border.
Scotland has also chosen not to follow English reforms that have seen patients, in discussion with their doctors, given more choice over which hospitals and treatments are the most suitable for their conditions.
Attacking the SNP’s NHS record will be at the heart of a Labour strategy that aims to hold the SNP to account for the last eight or so years it has spent in government.
According to Murphy, the SNP has escaped scrutiny because it has managed to portray itself as the party of opposition to Westminster.
Explaining his strategy, Murphy said he aimed to put the SNP “properly into government in the public’s eyes”.
“They have been both the incumbent and the insurgent all these years. We want to deny them the opportunity to be both the incumbent and insurgent. [We want] to place them into government and attach them to their own mistakes. In different ways that’s what we have been seeking to do… whether it comes to their record on the NHS, the winter crisis or fracking.”
Labour’s strategy has been supported by the focus group work that Murphy has been doing since he replaced Johann Lamont as leader.
Repeatedly, the NHS has been raised as an issue, reinforcing Murphy’s view that he has found Sturgeon’s Achilles Heel.
Describing the NHS as one of the SNP’s “big weaknesses”, Murphy said: “What comes up in the focus groups time and time again, is health and the NHS. A sense that they have been in power for nearly eight years and yet the rate of growth of spending in the NHS is less than David Cameron’s. I think when you share that fact with people in the focus groups, first of all there is a scratching of the head in bewilderment and at the end of the conversation there is a genuine sense of, ‘How can that be right that it is happening in Scotland?’”
Murphy’s statement is based on analysis by the Institute for Fiscal Studies (IFS), which calculated that between 2009/10 and 2015/16 spending on the NHS in England will have risen by four per cent in real terms despite an overall fall of 13 per cent in English departmental spending.
According to the IFS, there was a contrasting story in Scotland where spending on the NHS in Scotland will have fallen by one per cent over the same period – despite Scotland’s budget being protected by the Barnett Formula.
The SNP may be riding high in the polls, but there are some signs that concerns about its stewardship of the NHS are gaining some traction.
When the Scottish Cabinet went to Dumfries and Galloway last week for its first away-trip of the New Year, ministers faced some rumblings of discontent.
A public discussion in Dumfries saw complaints about bed-blocking, the phenomenon that sees elderly patients stuck in hospital when they are well enough to go home because there are no social care beds available for them.
This lack of slack in the system is just one of several NHS “pressure points” that Murphy intends to highlight over the coming weeks. For clinicians it is an absolutely critical issue. According to one leading doctor, the problem stemmed from the notion family doctors would take pressure out of the system by performing more routine tasks that had traditionally been done in hospital.
But with GPs changing tack to an approach based more around preventative medicine, bed-blocking remained an issue.
The Scottish Government’s solution has been to integrate the commissioning and delivery of adult health and social care under a single budget. While many support such a move, there is frustration that it is taking time to bear fruit.
The role currently played by GPs, who are facing their own recruitment problems, will also be part of the strategy adopted by Labour. There are frustrations over a lack of GP availability with recent research from the Reform Scotland think-tank revealing that many thousands of patients are unable to see the doctor on the day of their choice, with long waits for an appointment.
The gradual move away from a Dr Finlay-style on-call service has led to Labour calling for a front line fund to ensure a “seven days a week” NHS.
The lack of GP cover at evenings, weekends and holidays has had a knock-on effect on hospital accident and emergency departments, which have been struggling to cope over the winter.
Reports of patients waiting for up to 12 hours – three times longer than the official target in accident and emergency units – have been made in five different health board areas. Some of the longest waits were in Greater Glasgow and Clyde hospitals, with one patient being kept in a resuscitation unit for 24 hours before a suitable bed was found.
Dozens of operations were cancelled to make way for emergencies, and on one recent Sunday, 58 patients were kept on trolleys in one west Scotland department. Aberdeen Royal Infirmary has also come in for criticism with reports identifying A&E treatment times being missed, cancer waiting targets missed, fewer nurses to beds than in other hospitals and that patient safety could be at risk.
These problems have been recognised by the newly appointed Health Secretary, Shona Robison, who last week established a national review into the way that GPs provide out-of-hours care.
As the election approaches, the political parties are finding the time to work out their NHS strategies. For those on the front-line, there is no such luxury.
“One of the things that goes when you have fire-fighting is any sort of form of medium to long-term planning,” said MacLeod. “If you have got clinical managers in hospital and managers of clinical services who are being pulled hither and yon to sort out today’s bed crisis, then any long term planning and strategy is difficult.”