Recent headlines concentrated on NHS boards having debt cancelled though that does beg the question of why several are in such a mess in the first place. More important, says McClaren, are assumptions about future growth in spending.
In Scotland, he found, projected growth is 3.5 per cent over the next five years in cash terms while in England it is 6.7 per cent. At the same time, it is assumed the NHS in Scotland will make “efficiency savings” at almost twice the rate as in England. And if it doesn’t ...?
Even more concerning is the Scottish Government’s response. NHS spending in Scotland, they say, is seven per cent higher than in England, so what’s the problem? Well, it would be astonishing if it was not higher given that overall public expenditure in Scotland is 16 per cent more per head of population.
McLaren’s fundamental point is that there is simply not enough scrutiny of health spending and future requirements in Scotland. It is too easy to make assumptions which kick future failings into touch.
The need for scrutiny applies more widely. Why has local government been subjected to cuts at five times the rate of the reduction in the Scottish Government’s own budget? Why has every penny of NHS-related Barnett consequentials not been passed straight to the NHS? What alternative priorities outstrip these needs? Maybe there are good answers, maybe not. But first the questions have to be asked – persistently.