Leaders: Salmond plays high-risk game | NHS

ONE of the strengths of the Yes Scotland campaign is that it reaches out beyond those who would traditionally call themselves nationalists.

First Minister Alex Salmond. Picture: Getty

Much of its pitch is to people who this newspaper last year identified as the “I’m not a Nat, but…” sector of the electorate. This group of voters is crucial to any hope of a Yes victory in September. The number of committed nationalists in Scotland has remained pretty steady over many years at about a third of the voting population – not enough to win independence. So success for the Yes camp depends on non-nationalists lending their support to what is essentially a nationalist cause. The SNP should be a master at this. It is, after all, the technique the party used to win power in two Holyrood elections, in 2007 and 2011. In both these contests, Alex Salmond deftly persuaded Scots who did not believe in independence to back a party that had independence as its raison d’etre.

Increasingly, however, Salmond seems to be using some aspects of the referendum campaign as Obama-style “teachable moments” to try to convert voters to a nationalist mindset; to make them full converts to the nationalist cause rather than just fellow travellers. The first sign of this was in the negotiations that led to the Edinburgh Agreement between Whitehall and Holyrood. A number of Whitehall’s negotiating positions were condemned by Salmond as an outrageous slight on Scotland and the Scots. Much of this outrage was temporary and tactical – Salmond eventually agreed to most of the conditions with little complaint – but his conduct during the negotiations was aimed at igniting a sense of righteous outrage and indignation within the hearts of Scots voters. What he wanted to encourage was the perception that any attempt to put an obstacle in his way was not an act against a political leader of a particular party stripe, with a particular constitutional goal, but an insult to the whole Scottish nation.

Last week saw the latest manifestation of this phenomenon, when Bank of England Governor Mark Carney visited Edinburgh to discuss Salmond’s proposals for an independent Scotland continuing to use the pound, central to which is an element of Scottish control over monetary policy for the resulting cross-border sterling zone. Salmond’s tactic in this case was to act as if he was already the First Minister of an independent Scotland, presenting opposition to his plans as opposition to Scotland’s national interest. The message was clear: I am Scotland, and you are either for me or agin me. Not everyone in the Yes camp is comfortable with this.

The referendum debate is between Scots who want independence and Scots who do not. There is a recurring narrative in the Yes Scotland campaign that tries to frame the referendum as a battle between Scotland and “London”; or between Salmond and David Cameron. The aim seems to be that voters will identify SNP positions as pro-Scottish and any opposing views as anti-Scottish. The calculation would appear to be that this approach will generate a “my country, right or wrong” feeling that finds ultimate political expression in a Yes vote. This is more than just a category error. It is a naked attempt to turn Scottish patriots into Scottish nationalists. This is a perfectly legitimate political strategy, but it is also a high-risk one.

The problem for Salmond and his Yes Scotland colleagues is that patriotism and nationalism are actually two very different things. And by fostering a feeling of antagonism in the way he has been doing, the First Minister risks alienating the “I’m not a Nat, but...” voters. These Yes voters’ disquiet about nationalism is sincere, and the Yes Scotland campaign would be wise to respect this. If Salmond aims for a nationalist majority, rather than just a Yes majority, he risks losing as much support as he may gain.

NHS must preserve human touch

THE best doctors are those who treat the whole patient, rather than just treating a broken bone or a tumour or a disease. They see a patient not as a list of symptoms, but as a human being. They listen attentively and are alert to body language, tone of voice and general demeanour. They soothe fears and, where possible, provide reassurance. They are exemplars of their profession, and they are one of the reasons why most people’s experience of our National Health Service is a positive one. At its best, the NHS is a people-centred organisation with a human, caring touch and a good bedside manner. That is why it is a much loved – and fiercely protected – national institution. And it is hard to see how the proposed changes we describe in our news pages today can do anything other than threaten this hard-won esteem.

The move to cut back on outpatient appointments at Scottish hospitals is doubtless an effective way of saving money. But it comes at a price that is harder to put a figure on – a potential cost in compromised patient care. Can a telephone or video consultation really be as effective as a face-to-face meeting with a living, breathing, corporeal patient? Can it really be as accurate at picking up subtle signs and symptoms that may be relevant to that patient’s condition? If not, then how can we justify this in our hospitals?

One particular concern is that patients – especially the elderly – often have more than one thing ailing them. A face-to-face consultation allows a skilled medical professional to pick up potential signs of other problems that may be unrelated to the reason for the appointment. The chances of these being picked up in the course of a telephone or video conversation about a specific problem are much reduced. Empathy, kindness and the caring touch are also much harder when the communication is by electronic means.

Communications technology has an important part to play in modern medicine –particularly in more remote areas such as Scotland’s island communities. But it cannot take the place of the most basic form of interaction between a consultant and a patient.