Kate Forbes: Ministers must be willing to ‘take the flak’ for tough decisions on NHS

The former finance secretary warned against ‘ballooning bureaucracy’ in the health service
Kate Forbes. Picture: Jane Barlow/PAKate Forbes. Picture: Jane Barlow/PA
Kate Forbes. Picture: Jane Barlow/PA

Ministers must be willing to "take the flak" for tough decisions on the NHS, Kate Forbes has said.

The former SNP leadership contender warned there is a risk the health service's "ballooning bureaucracy" is taking money away from the front line.

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In a blog post for the think tank Reform Scotland, she backed calls for a “national conversation” on the NHS, adding: “But only if it leads to results”.

Ms Forbes, the former finance secretary, said only NHS workers kept the health service from “keeling over” in 2023 and despite their “herculean efforts” patients are “waiting too long for almost every service”. She said NHS staff were “plumbing new depths of fatigue and pressure”.

Dr Iain Kennedy, chairman of the British Medical Association (BMA) in Scotland, previously warned the NHS in Scotland may not survive the next 25 years without action. Former NHS Scotland chief executive, Professor Paul Gray, has also called for a conversation on the NHS – leaving open the possibility that some services could become paid for in the future.

Ms Forbes, the MSP for Skye, Lochaber and Badenoch, wrote: “We’ve heard talk of reform in the NHS for years – but without urgent interventions there might not be an NHS to reform in a few decades. The greatest risk, however, is the wrong diagnosis of the root causes, which will be inevitably followed by incorrect treatment.”

She said there needed to be a “frank debate” within set “parameters”, adding: “And Government should implement changes, even while the conversation is ongoing, by giving a cast-iron guarantee that they will back effective, sensible results, even if it comes at a cost – financially or politically.”

Ms Forbes suggested four parameters, with the first being “zero tolerance of any suggestion of moving away from the founding principles of the NHS, especially ‘free at the point of need’”.

Secondly, she stressed the NHS “exists for the patients and not the government”, adding: “If preventative spend works, then we should see change to acute care – but somebody has to be willing to take the flack for the tough decisions first.”

Thirdly, the MSP for Skye, Lochaber and Badenoch argued against extra bureaucracy. She said: “There was a day – or so I am told – when the ratio of doctors to managers meant that the administrative burden fell on clinicians. Now, there’s a risk that the ratio of managers to doctors mean we’ve quadrupled the administrative burden to keep pace with the ballooning bureaucracy, leaving less budget for the front line.”

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Lastly, Ms Forbes cautioned against rearranging the deck chairs “while the ship sinks”. She said: “Major structural reform might be required, but it will inevitably distract from the simpler changes that could be made and will need to be made irrespective of structural reform.”

She added: “Free up resources in the deep recesses of management in order to employ more frontline staff, and you probably don’t need to put everything on pause whilst you redraw the NHS.”

Michael Matheson, the health secretary, said staffing in NHS Scotland is at record levels and last month’s Budget provided funding of more than £19.5 billion.

He said: “Under this Scottish Government, Scotland’s NHS will always remain in the hands of the public and be free at the point of use.

“We know our approach to planning and delivering health and care services needs to change to enable recovery. Our policy prospectus and Programme for Government is explicitly clear: reform is required.

“But the fundamentals of Scotland’s NHS will not change; we remain committed to free access to health, to the improvement of health outcomes across Scotland, and to the reduction of health inequalities that persist in our communities.”



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