I thought Steven McNicholl as Cliff in the latter at the Royal Lyceum stole the show, but I’m no expert.
Nor am I an expert in health service re-organisation, but I know enough from colleagues on the Edinburgh Integration Joint Board, the health and social care partnership between NHS Lothian and council care services, that urgent reform is badly needed.
In England, reform is coming in the shape of the UK government’s Health and Care Bill, the biggest piece of health legislation for ten years which is expected to be passed this spring.
I don’t know how many conversations Mr Tennant, a prominent Labour Party supporter, has had about the crisis in healthcare provision across the UK, but he is confident enough to put his actorly skills behind the “Your NHS Needs You” campaign to oppose the new Bill.
Supported by the likes of Stephen Fry and comedian Frankie Boyle, they claim the bill will “pave the way for the English NHS to be replaced by the profit-driven American system”.
Describing the NHS as a “national kindness” which saved his life and that of his daughter, and detected and successfully treated his wife’s cancer, Mr Tennant added: “The fact the NHS exists makes us all better people. We tinker with that at our peril.”
There is no question the bill is controversial, particularly giving the UK health minister the power to intervene in local decision-making and the requirement to be notified of any operational changes, large or small, which sounds like a recipe for paralysis as minor decisions lie in a Whitehall in-tray awaiting approval.
The case for intervention is perhaps understandable, given the preventable scandals in which the NHS was nothing like the “national selflessness” Mr Tennant claims it to be; at Bristol Royal Infirmary around 170 babies who would otherwise have survived died after heart surgery between 1986 and 1995, at Stafford Hospital between 2005 and 2008 it is alleged there were up to 1,200 preventable deaths, while 11 babies and a mum died at Furness General around 2008.
But is the bill, as opponents argue, American-style private health by stealth?
According to campaigners for health reform, it’s anything but. The Nuffield Trust notes a “shift away from a marketised way of working” and observes that “changes to create a more cooperative NHS at a local level represent the right direction of travel”.
The King’s Fund, which has campaigned to improve healthcare for the underprivileged since 1897, says the Bill “proposes to reduce the role of competition and increase the flexibility around procurement rules, but does not necessarily have particular implications for the involvement of the private sector”.
Recognising criticism, the King’s Fund argues the Bill “aims to place collaboration, rather than competition, at the heart of how healthcare services are organised”, and notes the proposals “have been informed by the NHS’s recommendations”.
That being so, it appears the legislation is being attacked more because of the party putting it forward than what it is trying to achieve, and in moving away from a market-driven model is actually more likely to undo increased external market choices for patients introduced by a Labour government for which the likes of Mr Tennant campaigned enthusiastically.
If anything, it’s Conservatives who should be concerned about the removal of market-driven choice and centralised rubber-stamping of decisions, not left-leaning luvvies.
But what Mr Tennant has ably illustrated is the belief that the NHS cannot be altered in any way at all. Never mind wholesale reform, it can’t even be “tinkered with” and seemingly the only other way of addressing problems as our ageing population increases, waiting lists lengthen and the system reels from Covid’s knock-on effects on all conditions, is to throw more public money at it.
As anyone who attends Scottish integration boards and their equivalents in England will testify, health and social care services are on their knees, but lack of money is only part of the problem.
Pre-pandemic, up to 30 per cent of acute beds were occupied by people awaiting discharge. The Edinburgh health and social care board managed a surplus of £1m last year, but only after a savings programme and increased Covid funding from the Scottish government as costs rose from a forecast of just over £700m to around £850m.
Despite the inextricable link between hospital treatment and care, the systems are dogged by lack of capacity, effective co-operation and inefficiency, and remain resistant to minor modernisations.
In August, Cancer Research UK reported 30 per cent of cancer patients had their treatment disrupted by Covid and the effect of interruption and delay on mortality rates are yet to be fully understood.
But in November the Office for National Statistics revealed a 29 per cent increase in deaths in private homes in 2020, mainly from heart disease, cancer and dementia, and between March 2020 and October 2021 just over 75,000 more people died at home than would normally be expected, a pattern with massive implications for healthcare if it continues.
April’s 1.25 per cent hike in National Insurance will raise £12bn a year for health and social care, yet there’s no guarantee it will make a significant difference to the system and won’t change the way we access services or give us any choice in how the extra money is spent.
The pandemic has demonstrated how the NHS trumps all other priorities, particularly in Scotland, but also how public and private interests cooperating on a not-for-profit basis can deliver life-saving programmes at previously unimaginable speed. When actors and comedians try to prevent such partnerships developing, the joke is on us.
John McLellan is a Conservative councillor in Edinburgh