Christine Jardine: SNP running of NHS off-target

Picture: Jayne Wright
Picture: Jayne Wright
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GOVERNMENT must admit mistakes over political use of waiting lists and start listening to the health 
sector, writes Christine Jardine

This week’s headlines have confirmed what many of us have feared for some time. All is not as rosy with the National Health Service in Scotland as our government in Edinburgh would have us believe.

The NHS is suffering from a number of problems and those responsible for looking after it seem bereft of cures.

It is in all of our interests to guide the service back to rude health and fears being expressed by critics in both the political and medical fields are not partisan mischief making. No, they are expressions of concern based on evidence.

First there was the scandal of patients being left in wards without blankets. Then there were those left for hours in hospital corridors, and finally confirmation that the proud boast of guaranteed maximum waiting time of 18 weeks was little more than a mirage.

Deputy First Minister Nicola Sturgeon now finds herself under fire over the management of those waiting lists when she was in charge of the health brief.

Originally, it was revealed in 2011 that NHS Lothian had been manipulating figures to show that it had met its targets, making its performance look good on paper while, in reality, patients were having to wait longer for treatment.

Then an Audit Scotland report claimed that it was possible that a number of health boards could be using the same excuse that patients were “unavailable” for appointments they were offered, to disguise how long they were actually waiting for treatment.

The use of that unavailability code had risen from 11 per cent in 2008 to about 30 per cent in 2011, and then dropped off sharply when the issue of their possible misuse by NHS Lothian became public.

Yesterday, The Scotsman revealed that despite a multi-million pound drive to boost the number of patients NHS Lothian could treat, new figures from the NHS Scotland showed that the numbers having to wait more than the target period for endoscopies had increased.

The same figures also showed the region to have the second worst record for waiting times in the country and that the area’s emergency departments are performing badly.

Coupled to the claim, also published yesterday, that hospitals across Scotland are more than 1,600 nurses short of the number they need, the picture emerging is not a healthy one.

When the Audit Scotland report on nationwide waiting times was discussed in parliament, the current health secretary Alex Neil denied there was any evidence of figures being massaged. He did, however, agree to carry out a review of waiting times management within a year.

But surely what we need is a fundamental change of approach, and not just one confined to waiting lists? They are a symptom of the problem, but they are not the illness.

What we need is for the Scottish Government to accept that they are getting it wrong. First they may have to admit that the issue is a home-grown one. Health is, after all, completely devolved.

It will not be good enough to simply point the finger of blame at Westminster and say “It’s their fault.”

The Scottish Government has been happy to take the credit when it could claim the NHS north of the Border was out-performing its counterpart in England and Wales.

Now it must both accept responsibility for the service’s shortcomings and recognise that the solution to the problem lies in its own management style and the “targets are all” attitude.

That is a problem highlighted both by the Audit Scotland report and an evidence session of the Public Audit Committee yesterday at the Scottish Parliament, which described the focus on targets in the health service as being “too narrow”.

The picture that has emerged, of a health service across Scotland driven to prioritise those targets, is one we are already familiar with elsewhere.

The Scottish Government’s doctrine of command and control from the centre is the model it adheres to across the public sector. It is not working.

Targets are all very well and can be useful. But the control and the determination of how and whether those targets are set surely needs to be given back to trained health professionals?

Should they not be allowed to decide what is best for their patients as individuals and the provision of services as a whole, rather than what will best meet their targets?

The current administration’s devotion to political management from the top down, instead of trusting public sector workers, is tying our system in knots.

The same sorts of issues that beset the implementation of the curriculum for excellence and the tension over colleges are also symptomatic of the government’s preferred model of top-down management and central control.

Delivery of vital services and educational changes are not hitting the mark because the advice, and in some cases warnings, from the professional experts take second place to political expediency.

After yesterday’s public audit committee it was claimed that the Auditor General made clear that warning signs were there but government didn’t listen.

This echoes a fear that many have already expressed over an issue that only emerged because a member of staff at NHS Lothian was prepared to blow the whistle on what was really happening.

It is still not entirely clear what the Scottish Government knew about this issue before it became public in 2011 or how much advice they were offered. If they are to begin to repair the problems they have to begin to listen to it.

• Christine Jardine is a former Liberal Democrat special advisor to the UK government.