Despite their claims, a body of evidence suggests stifling centralisation, writes Brian Wilson
The two reputational pillars which the Nationalist administration in Edinburgh has sought to build for itself involve repeated use of the words “competent” and “radical”. This week, they are both looking shooglier than ever.
Some of us never noticed much evidence-based justification for either. The radicalism is restricted to persuading the gullible to regurgitate press releases, as in “The Scottish Government today announced radical new plans/targets/vision…”. And that’s generally the last we hear of that.
I think the word “pedestrian” would be a more appropriate descriptor. There is remarkably little evidence of creative thinking, new ideas or looking elsewhere for inspiration. Since they are actually motivated by only one big idea – independence – none of that is deemed necessary.
As for competence, that is all about maintaining a front. Say something often enough and it acquires the status of received truth. “Oh, they’re very competent…”. Deny inconvenient realities glibly enough and they disappear. Swat opponents hard enough and this passes for political brilliance. Such has been the style of both Salmond and Sturgeon, and nobody can gainsay its effectiveness.
But inconvenient truths have a nasty habit of reappearing and once they start creeping into people’s own experiences, glibness and denial may not be enough. This week’s quite shocking report from Audit Scotland on the state of our National Health Service falls into that category.
Anecdotal experience is now backed up by hard analysis and seven failed tests out of nine. The wonderful work routinely performed within the NHS cannot disguise the fact that the system is fraying badly around the edges. There are too many reports from around Scotland of administrative malfunction, unacceptable delays, staff shortages, inadequate follow-ups, absurdly high payments for agency cover and so on.
Now that Audit Scotland has validated and quantified many of these concerns, even the SNP will find difficulty in blaming someone else, though that will not stop them trying. Statistical obfuscation seems to be their immediate defence mechanism but that means little to those at the sharp end, including GPs and patients.
At the heart of the Audit Scotland indictment is a damning statement: Expenditure on the NHS in Scotland has reduced by 0.7 per cent in real terms over the period of SNP rule at Holyrood. The NHS budget has not been protected, far less increased. Money which has come to the Scottish Government through health-related Barnett consequentials has been diverted elsewhere.
Not only does this directly contradict previous claims by Scottish ministers, it also puts them in the awkward position of having been less attentive to the fiscal needs of the NHS than the despised Tories at Westminster, who actually have maintained a real-terms increase in NHS spend in England since coming to office.
Most serious of all, it reflects a bewildering sense of priorities, which conflicts directly with the Nationalists’ self-publicity. Everyone knows the NHS faces huge challenges, some of them for the admirable reason that the NHS allows us to live longer; others due to such difficulties as recruiting and retaining staff, particularly in rural areas.
But how can anyone believe that the answer to meeting these challenges, as effectively as possible, can involve diverting resources away from the NHS rather than scraping together every available pound to strengthen it?
When similar questions have been raised in the past, curt answers from the Queen of Glib have accused critics of “talking down the NHS” and undermining those who work within it. Such calumnies will not suffice this time. Audit Scotland clearly lays responsibility where it belongs, cuts through statistical sleight of hand and warns of severe consequences unless change happens.
Less commented upon than the impacts of Edinburgh’s budgetary priorities is the role of its centralisation agenda and the political micro-management which flows from it. The paradox of devolution is that it has led to far less local control and decision-making, rather than more. That mentality may prove even more difficult to shift than the failings identified by Audit Scotland.
Before devolution, there was a Scottish health minister who set parameters and regional health boards were left to get on with managing and, if necessary, taking unpopular decisions. Ministers would ultimately accept responsibility if things went badly wrong, but they were not expected to intervene every ten minutes.
They could credibly say that a particular decision was the responsibility of a health board, and decline to interfere.
Now, as any senior health board figure will confirm, they are plagued with telephone calls from ministers, special advisers and pressurised civil servants, demanding actions and answers – not according to priorities which might lead to sensible management and necessary change, but to meet political imperatives of the moment. Too many politicians inevitably leads to too much politicisation.
It also obstructs the process of change which Audit Scotland insists is necessary to meet challenges which the NHS now faces. Instead, the agenda is driven by target-setting and headline-grabbing. And, of course, if ministers insist on involving themselves in micro-management of the NHS in search of plaudits, their opponents feel equally entitled to politicise their failings. And so it goes on.
Every aspect of Scottish life is now subjected to this process of centralisation which flows naturally from a Nationalist philosophy.
The National Police Force is not an overwhelming success. National Testing in primary schools is a retrograde step. The strangling of councils by fiscal means has neutered local democracy. And so it goes on. Surely there is enough evidence for a counter-attack not only on the symptoms but on the centralisation disease itself?
Meanwhile, let’s remember that the entire NHS budget in Scotland is £11.4 billion and it is struggling badly. But things could be very, very much worse. If, as was intended by Ms Sturgeon and her colleagues, we were now looking forward to Independence Day in six months time, we would also be in line for the loss of £8bn from the gap between current public expenditure and the promised revenues from the North Sea.
Planning for that happy day, while creating the circumstances reflected in the Audit Scotland report, is not so much a case of taking the eye off the ball as turning their backs on the whole field of play. Radical and competent? I think not.