Leaders: Holyrood powers | Postcode lottery
It quickly became a universal shorthand for the limited power to vary Scottish income tax by up to 3p in the pound that was one of the few fiscal powers handed to the Scottish Parliament when it opened for business in 1999. Lang intended it as a term of abuse.
The Tory argument was that this power would lead to Scotland being the most highly-taxed part of the UK – an argument resting on the ideological assumption that the Pavlovian instinct of any left-of-centre administration north of the Border would be to raise taxes. Lang was partly correct – the SNP fought the 1999 election promising to use the tartan tax power (a “penny for Scotland”) to boost education, health and housing. But in the 15-year history of the Scottish Parliament no elected administration has used this power.
Some observers regard this as a bit of a mystery. After all, if Holyrood has the power to offset the public spending cuts of the UK government, why not use it? Wasn’t home rule partly about protecting Scotland from the worst excesses of Tory rule at Westminster? The difficulty was that any Scottish government using the tartan tax for the first time would face tens of millions of pounds in set-up costs with HM Revenue & Customs. Ultimately, much of the tax raised would go toward the cost of actually raising the tax. In this basic form, the tartan tax was effectively unusable.
Then came the Calman Commission and the new version of the Scotland Act it spawned in 2012, reconfiguring the tartan tax so that these start-up costs would subsumed into the normal tax system. When the new Scottish tax authority comes into operation in April 2016, any decision to raise or lower income tax will not carry the same financial penalty in administrative costs. The ability to vary income tax will then become a mainstream aspect of political discourse at Holyrood. This week Scottish Labour is expected to propose that this power be extended further, to allow Holyrood to vary the rate at which income tax is paid within different tax bands – a infinitely more flexible tool.
These changes are why Scottish Labour leader Johann Lamont is now able to talk about Holyrood using tax for wealth redistribution, and why Prime Minister David Cameron can talk about Scots potentially having lower taxes than in the rest of the UK. This is a watershed moment in the history of Scottish devolution, ushering in a more grown-up politics where Holyrood is much more accountable for the money it spends, and where there is far less scope to blame Westminster for Scotland’s ills. The big question, however, is whether the advent of these new powers will have any effect on the independence referendum debate. At the moment this is hard to gauge. Few Scots are fully aware of the new powers already coming Holyrood’s way, let alone the ones that might yet be devolved from Westminster under proposals only now being advanced by the pro-UK parties. Little is known about whether Scots would be willing to vote for a party that proposed raising income tax (Scots did not seem very keen on paying that “penny for Scotland” in 1999, for example). Any party proposing to use Scottish income tax powers would first have to pause and consider the effect it would have on Scotland’s competitiveness with the rest of the UK and further afield.
There can be no doubt that Scottish politics has just changed. The debate on tax started by Lamont and Cameron this weekend takes us into new territory. Will it impact on the existential choice we all face on 18 September? That remains to be seen.
Patients should not have to face a postcode lottery when faced with serious illness
WHEN someone is ill there are few things more distressing than a long wait for a diagnosis. A patient cannot begin to be treated until doctors are sure of what ails them, and invariably this involves tests that can necessarily take a little time. A little time, yes.
But waiting more than a month before tests are even carried out can be a living hell. And that is before the subsequent wait for treatment. As we report today, thousands of Scottish NHS patients are having to wait more than four weeks for diagnostic tests – such as CT scans, MRI scans, barium studies and ultrasounds – as health boards in many parts of Scotland miss their targets.
This is unacceptable. Every extra week is a lifetime of worry for each of these patients and their families, kept in limbo and left guessing whether their symptoms are nothing to worry about unduly, or an indication of a life-threatening disease such as cancer.
The findings illustrate how much of a discrepancy exists between different parts of Scotland in the field of diagnosis. The Scottish Government’s actual time limit on diagnostic tests is six weeks, but it has set health boards a four-week target. The latest numbers show that the performance of some health boards – such as Fife and Lanarkshire – is much poorer in this respect than others, such as Greater Glasgow and Dumfries & Galloway. This does not appear to be a urban v rural divide, so why the postcode lottery?
There are three potential explanations. The first is an uneven distribution of demand. The second is a possible unevenness of distribution of MRI and CT scanners. And the third is the possible uneven distribution of top-class health managers. There is no evidence that the first of these is the case – the exemplary performance in Greater Glasgow, which covers some of Scotland’s areas of poorest health, would seem to indicate that. That leaves us with possible issues around equipment and variable management skills, on which reliable information is harder to come by.
Both of these factors should be the focus for a ministerial investigation into diagnostic waiting times in Scotland’s hospitals. Obtaining a swift and accurate diagnosis is part of the duty of care our NHS owes to each and every patient, regardless of where they happen to live.