NICOLA Sturgeon can expect to be challenged on the lack of choice in Scotland’s heath service, writes Kenny Farquharson.
The NHS is where we experience many of life’s indelible moments. The raw howl of a new-born baby delivered into the arms of an exhausted mother. The practiced calm of a consultant delivering devastating news from test results. The helplessness of surrendering a loved one into the hands of the professionals for an operation.
So it should come as no surprise that every poll asking voters what they care about most in the general election has the health service top of the list by some margin. The NHS touches lives like nothing else within the power of politicians.
And yet the NHS has still to become a central issue in the general election campaign north of the Border. There have been a few routine exchanges about A&E departments and the slow-motion car crash that is NHS Grampian. But Scottish politics has been otherwise distracted by opinion poll figures, the advent of Jim Murphy as Labour leader, and continuing speculation about the SNP role in a hung parliament.
This, I suspect, will not be the case for long. The NHS will make its presence felt in this election. Forget the obvious objection that health is a devolved matter and therefore nothing to do with MPs. People’s priorities have no respect for constitutional niceties, and their concerns cannot be so easily compartmentalised.
My prediction is that when the NHS comes to dominate this campaign, as it surely will, it could spell trouble for Nicola Sturgeon.
Mr Murphy has spent the past two decades as an uncompromising advocate of Blairism in its purest form. On some of his political beliefs he has proved himself willing to do handbrake turns of such tyre-shredding suddenness they have left long-time observers of his political career a tad bemused. But there are some stripes this zebra would find hard to change, and one of these is the key Blairite commitment to choice in frontline public services.
The First Minister has surprised her opponents – and dismayed some of her supporters – with her willingness to embrace Blairite education reforms such as the London Challenge. She was getting her retaliation in first, in anticipation of a Labour attack along classic Blairite lines.
But with the NHS Ms Sturgeon is on trickier ground. After all she was cabinet secretary for health between May 2007 and September 2012, before being reshuffled to the referendum campaign.
A lot can happen in the vast and sprawling NHS in five years. And a lot that should happen but doesn’t.
Ms Sturgeon can embrace a Blairite schools reform because she was never in charge of schools. But can she really, with credibility, embrace a Blairite health reform? The unavoidable question would be: Why didn’t you do this when you were the minister?
If a Blairite Scottish Labour leader was to go for the SNP on health, my guess is the target would be patient rights.
Because the hard truth is that NHS patients have more rights in England than they do in Scotland.
A glance at two contrasting documents is illuminating.
In England, the NHS Constitution sets out a whole range of patient rights and options for treatment.
A typical passage reads: “If your GP refers you to see a consultant you may have a choice of a number of hospitals. You might want to choose a hospital that has better results for your treatment than others, or one near your place of work. Ask your GP for more information. You can find and compare hospitals on this website.”
The website allows you to check the performance of individual consultants or hospital departments in your area, in the medical speciality that concerns you. The detail is extraordinary. It allows a patient to make informed choices about his or her treatment.
There is no such Scottish website. And none of these rights is spelled out in the equivalent Scottish document, Your Health, Your Rights: The Charter of Patient Rights and Responsibilities, originally published in September 2012 and last updated two months ago.
This is a far more stern document than its English counterpart – it seems to spend a lot of time on the responsibilities and expresses the rights in bland generalities.
You have a right to a GP, for instance. You have a right for your medical records to be kept confidential. Fair enough. But I’d like to know if the surgeon replacing my mother’s knee is any good, or if she’d be better travelling to another hospital an hour away to see an undisputed leader in that field.
I don’t doubt that some hard-nosed NHS patients in Scotland may well be able to insist on a hospital of their choice, with a surgeon of their choice, at a time of their choice. I know, because in the past I have been that hard-nosed patient.
But for the vast majority of people in Scotland these choices are never spelled out. Most patients are oblivious to the options they have, or even that options exist. It’s only a right if you know you have that right, and you are free to exercise it.
The NHS in Scotland still operates on the assumption that we do not want any choice. We do not want GP appointments in the evenings or at weekends. We do not want control over our own treatment. We do not want the best surgeon to operate on our children or on our parents – we’ll be happy with whoever turns up and puts on a green gown on the day.
This isn’t the 1950s. We have become accustomed to making choices, using our own judgments on the important things in our lives, and that includes our health and the health of our families.
With her embrace of the London Challenge, Nicola Sturgeon signalled that the days of one-size-fits-all public services in Scotland may be numbered. This is tremendously encouraging.
But is she willing to admit she may have got it wrong on patient rights?
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