The truth about why NHS Scotland is cancelling operations.

Cancelled NHS Scotland operations were in the news yesterday – there have been around three thousand cancelations this year. Whilst this makes a change from reports of A&E waiting times targets being missed, the two issues are related. Both are linked to “delayed discharge” (AKA bed blocking).

Delayed discharge is where a patient is judged clinically ready to go home but continues to occupy a hospital bed while plans are made for appropriate follow-up care. These plans can be complex, but can also be as trivial as fitting a handrail on someone’s bath at home. At any one time hundreds of patients can be waiting weeks for discharge. This is bad for them and bad for the NHS.

To be fair to the SNP’s Health Secretary, Shona Robison, she said cutting the number of people stuck in hospital waiting for a care package to be arranged is an “absolute key priority” for the Scottish government. Indeed, she committed £100m to solving the problem (a few months earlier £5m was enough). On the 25th of February in a BBC interview she said:

“I want over the course of this year to eradicate delayed discharge out of the system and I am absolutely determined to do that.”

Indeed, the seriousness of the issue led to Ms Robison invoking Nicola Sturgeon’s name a few weeks earlier:

“In presenting the Government’s programme for the year ahead, the First Minister made it clear that addressing delayed discharge is one of our key priorities and it is one to which I give my personal commitment.”

There we have it. With the support of Scotland’s First Minister and £100m in her pocket, Shona Robison gave a “personal commitment” to “eradicate delayed discharge” by the end of this year. How did she do?

Of course the year is not over yet and we will not have data for some time, but the situation up to October  was pretty poor. The official assessment:

“In October 2015, there were 50,945 days spent in hospital associated with delays in discharge. This is a 6% increase from September and a 9% decrease on the same period last year. “

 

So whilst the SNP’s apologists may want to suggest that cancelled operations can be attributed to “acts of god”, alert readers will perhaps argue that the SNP could be doing more to deal with the delayed discharge of patients.

 

 

 

 

 

 

 

How #SNPBad is stifling political debate in Scotland.

In most countries in the developed world politics is about left versus right. Broadly speaking the left tends to believe in equality of opportunity in a society underpinned by strong public services which are funded by progressive taxation. The right believes in a small state and giving people the freedom to generate and retain wealth.

Throughout my life,  politics in the UK has been fought along these lines. With the Conservatives always keen to reduce public spending to a minimum and Labour keen to invest in the NHS, education and training.

Whilst the traditional battlelines have changed little at UK over my lifetime, in Scotland  they have been shattered. The debate here is no longer about right versus left for many, it is about independence. This suits the nationalists nicely as they have always followed an ideology free populist agenda.

Indeed, one of the nationalists’ great successes has been to turn the debate away from socialism versus toryism to unionism versus nationalism. Politics is no longer about ideology, it is about identity. For many Scots identity and nationalism have become more important than policy or record in government.

For hardcore nationalists, failing hospitals, falling numeracy in our schools and broken bridges are either overlooked or accepted as the price worth paying for having a nationalist government. The pseudo left in the nationalist ranks even attack Labour heroes such has Gordon Brown (he took 2 million people out of poverty) whilst defending nationalist policies which make the rich richer (APD cuts, council tax freeze and cooperation tax cuts).

In “unionist” ranks there is a similar problem. There is an intransigent hardcore which oppose our nationalist government just as strongly as nationalists blindly support it. Scotland is polarised.

Caught in the middle between entrenched unionists and angry nationalists are the people who don’t define themselves along the redrawn political battlefront in Scotland, but simply want the country to be run well. They want their children to have a world class education. They want to know the NHS is working well and will be there when they need it. They want pothole free roads. They want their bins collected.

Also in the middle ground between unionists and nationalist are many people like me. I want Scotland to be a fairer place where every child has an equal chance of reaching their full potential. Like many Scots, this outlook defines my politics, not the constitutional debate. I voted No in the referendum as I thought that was the best way of delivering that vision. Although I still feel that that was the right way to vote, it does not define my political outlook. I know Yes voters who feel the same.

Although we frequently hear that “Scotland has never been so politically engaged”, the fractured political landscape I have described is actually stifling debate. Week-after-week we see calls from the left  to make Scotland a fairer place shut down by the nationalists by claiming the debate is driven by anti-nationalist zealotry.  Discussion of failures in the NHS, Police Scotland and education are avoided using the same tactic.

This week Magnus Gardham discussed this problem in The Herald when he highlighted the propensity of nationalists simply dismiss legitimate questions and comment as “SNP Bad”. He summed it up like this:

“SNP bad is one of the year’s most striking phenomena. It began as a meme on social media, as Nationalists took to dismissing anything critical of or embarrassing for the SNP government as “SNP bad”. It was eagerly picked up by tweeting MPs and MSPs and has now entered the political lexicon at Holyrood, trotted out by backbenchers and even ministers answering parliamentary questions. It’s not a good thing.”

Even as a member of the Labour Party, I am happy to accept that Scotland’s nationalist government is doing the right thing in some areas. For example, I am broadly supportive of their review of university governance and give up a great deal of my time to support their Construction Scotland Innovation Centre. However, even the staunchest nationalists must also recognise that, after almost nine years in government, there are some real problems in education, health and policing in Scotland.

Given the lead that the nationalist have in the polls, and the majority they have in Holyrood, more than ever they have a duty to be honest with Scots about the problems Scotland faces. They must show that they are not above admitting their failures, smart enough to benefit from the lessons learned from them, and strong enough to correct them.

 

Some examples of SNP bad:

The nationalists have had responsibility for the FRB since 2007. They cut its funding and privatised its maintenance. When it fails, Pete Wishart MP says:

Trying to blame the SNP for a crack in the FRB must be the most inept and desperate attempt at 'SNP baad' in all the unionist baadlands.

— Pete Wishart (@PeteWishart) December 10, 2015

 

A nationalists responds to this question “How do you market a product? What’s the best way to get funding? Got any business questions for @bbcr4today experts?”:

@BBC_HaveYourSay @BBCr4today #snpbad ? pic.twitter.com/3U4WEMhdP2

— Starbright (@STARBRIGHT164) December 28, 2015

The Guardian points out education is being cut to fund healthcare in Scotland. This alert reader says:

The Guardian view: "SNP still bad." https://t.co/1LS3YBs3t0

— Wings Over Scotland (@WingsScotland) December 21, 2015

A journalist points out that the nationalists have cut the grants for the poorest students:

It's #SNPBad when you allow a journalist to promote her own personal anti-SNP views unchallenged. https://t.co/sGPelAknJr

— GAPonsonby (@GAPonsonby) December 27, 2015

 

 

 

 

 

 

 

Where is the Scottish alternative to austerity we were promised by the SNP?

After all the rhetoric from the SNP on their desire to create a fairer Scotland and independence  being a chance to rid us from Tory governments for ever, John Swinney’s budget was always going to be a test. He failed.

Instead of taking Scotland down a different path, the SNP now have virtually the same tax policy as the Tories in Scotland. The easy thing for the SNP to do would have been to end the Council Tax freeze as it is an inequitable policy which has made the rich richer. Swinney failed to meet that challenge.

Raising Income Tax was always going to be difficult as the new powers he has on this are quite crude when compared to what will come when the Scotland Bill is enacted. However, government is about leadership and I feel Mr Swinney should have at least had Scotland consider the benefit of increasing income tax and channelling the money directly to where it is needed most if we are to tackle inequality at source: education. Again, he failed to meet this challenge.

Anyone who wants to create a fairer Scotland will quickly conclude that John Swinney’s budget has done nothing to cut inequality in Scotland. The SNP appear to specialise in t-shirts and bumper stickers  on tackling inequality, it’s a real shame their policies don’t match.

Where is the Scottish alternative to austerity we were promised?

People who think the SNP can do no wrong should take the time to speak to one of the 160,000 people who work for the NHS in Scotland.

The news that only 26% of nurses feel that their department is sufficiently staffed comes as no surprise to me (report 12.12.15). Last week I attended Edinburgh Royal Infirmary to undergo surgery and many of the staff there spoke openly about the stresses they were facing.  

The nurse who took me to theatre did so in her lunch break. Another told me of how the closure of the Forth Road Bridge meant that, on top of a 12 and a half hour shift, she faced 3 or 4 hours of driving each day. I saw a doctor offer to take casework off an overloaded ECG specialist. All this was in the space of a few hours. 

On discharge I was asked to make an appointment with my GP practice within 72 hours. On calling, I found that no appointment was available for two weeks and that I had to rely on good will to be seen. 

This act of good will typified my experience. Every member of NHS staff I met during my 24 hours in the ERI was absolutely dedicated to their job and willing to go the extra mile to help patients and colleagues.  

It is a real shame that we don’t have a government in Scotland that values the NHS in the same way. In recent months they have asserted that their council tax freeze has been “fully funded” to the tune of around £500m per year, whilst the IFS and Audit Scotland have stated clearly that the NHS is being underfunded by over £300m.   Government is about priorities, and the SNP appear to think that a policy which benefits the richest most is more important than giving our NHS the resources it needs.  

People who think the SNP can do no wrong should take the time to speak to one of the 160,000 people who work for the NHS in Scotland. Maybe then we can start the work of giving the NHS is resources it deserves.

Fact Checked – The Wings over Scotland Blog on the Forth Road Bridge Closure.

Campbell starts his blog by admitting he’s “been struggling to get a good grip on what’s happening with the Forth Road Bridge this week”. This is evident as he fails to mention either Derek Mackay’s duplicity or the 65% capital spending cut Audit Scotland noted was imposed by the SNP.  But let’s look at the six points he does raise.

1. It is all Labour’s fault (Labour = Bad).
Firstly, FETA was not a “non-government organisation” (AKA NGO), it was a “Quasi Non-Governmental Organisation” (AKA QUANGO). Suggesting that the Scottish Government had no control of FETA is bonkers – it set its budget and was able to privatise it. Furthermore, suggesting Labour Councillors were somehow to blame for the cancelation of maintenance in 2010 is silly. There were some good engineering reasons for this delay, but Audit Scotland also noted at the time that the Scottish Government “Funding arrangements continue to provide management with challenges”.

2. FETA was Funding Work from its reserves 2011.
FETA did, wisely, hold a contingency reserve. However, its reserves were buoyant in 2011 as the Scottish Government was providing funding in advance. This is clear when we put Campbell’s quote in context: “The effect of advanced grant funding has been that FETA instead of having to draw down reserves for increased capital expenditure has increased its net reserves. However, FETA is planning to use its reserves to meet future capital expenditure”. Nonetheless, he April 2014 minutes are absolutely clear that work was deferred in 2011 due to a spending review.

3. The replacement work would have entailed the closure of the bridge for a significant period.
Campbell provides no evidence to substantiate this, nor does he define “significant”. The FETA minutes are clear that there would be “disruption”, but this is not detailed – it could be anything from speed restrictions to full closure. In any event, a proactive closure would be better than the crisis we currently find ourselves in.

Importantly, FETA favoured repair to replacement (less cost  and disruption).

4. Replacing the failed component in 2010 might simply have seen the bridge having to be closed twice.
This is pure speculation which ignores the fact that Derek Mackay has said the 2010 work would have seen the failed component replaced:

5. The removal of bridge tolls is a red herring
No, the tolls gave FETA the budget it needed to inspect, maintain and operate the bridge. By removing them, FETA faced cuts at the hands of the SNP.

6. Work on the Queensferry Crossing should have started sooner.
This is a red herring. If the condition of the existing bridge was justification for building a whole new bridge, why cut its inspection, maintenance and operation budget? Think about it.

 

Conclusion
Some of the above is arguably differences of opinion. Nonetheless, it is very clear that Campbell is exhibiting confirmation bias. Something we all suffer from time-to-time. 😉

 

Forth Road Bridge “truss end links” – A timeline.

This timeline is based on Forth Estuary Transport Authority meeting minutes (all here) and Audit Scotland reports. I note that work on the Truss End Linkages was deferred at least 3 times:

1. From 2012/13 to 2013/14
2. From 2013/14 to 2014/15
3. From 2014/15 to 2015/16

(n.b. 2011 deferrals are not noted)

 

Timeline

August 2006: It is noted that the “existing truss is overstressed and will require to be strengthened”

October 2009: An assessment of the Truss End Linkages has been undertaken. (Capital Plan to 2023/24, October 2009)

October 2010: Audit Scotland notes that “Funding for 2011-2014 has still to be agreed with the Scottish Government” and that “Funding arrangements continue to provide management with challenges”.

May 2010: A tender for work on the truss end links is cancelled.

2011: Maintenance projects deferred due to a spending review. (Minutes, April 2014)

August 2011: Audit Scotland notes that Funding for 2012-2015 has still to be agreed with the Scottish Government and that “Funding arrangements continue to provide management with challenges”.

2012: A second round of projects were deferred.  The “Truss End Linkages” were considered for deferral, but were found to be “vital to maintain the operational capacity of the bridge and were retained in the programme”. (Minutes, April 2014)

October 2012: Audit Scotland notes that FETA has a “significantly reduced capital grant” and is  “experiencing a 65% reduction in its three year capital grant to 2014/15”. Audit Scotland note that this “may impact on future project costs”.

August 2013: It is noted that Truss End Linkage strengthening  is going to tender and that the work was deferred from 2012/13. (Budget Monitoring 2013/14, August 2013)

February 2014: It is reported that the Truss End Linkages are “significantly overstressed”. Based on cost and potential disruption, replacement is ruled out. Strengthening is to be trailed on the south west tower. It is noted that strengthening will cost £0.434m, whereas a repair will be £10m-£15m. (Minutes, February 2014)

October 2013: Audit Scotland again notes that FETA has a “significantly reduced capital grant” and is  “experiencing a 65% reduction in its three year capital grant to 2014/15”. Audit Scotland note that this “may impact on future project costs”.

February 2014: “Truss End Linkages project” deferred to 2015/16 “due to issues with the design check”. (Budget Monitoring, 2014/15)

February 2014: Costs associated with Truss End Linkages are expected to defer to 2014/15. (Budget Monitoring 2013/14, February 2014)

February 2014: Full Replacement (not strengthening) of Truss End links is deferred to “post 2015/16 due to budgetary restraints”. (Revenue and Capital Budgets, 2014/15)

February 2015: Truss End Linkages strengthening delayed due to “issues with the quality of the existing tower steelwork; the difficulties of access and the existence of red lead paint, coupled with the loss of key management staff”.   Strengthening to be trial on the south west to be completed by May 2015. If successful, the remainder of the work will be undertaken by Transport Scotland in 2015/16. Further analysis is also being undertaken to re-assess the current capacity of the links to carry Abnormal Vehicles. It is noted that “this work may result in an operation restriction on the passage of the heavier loads that cross the bridge and may increase traffic disruption”. (Capital Plan and Reserves Update, February 2015)

December 2015: Bridge closed.

Forth Road Bridge “truss end links”.

We know the Forth Road Bridge is closed due to a “north east tower truss end link” defect.  This is a pain for me as I live in Edinburgh, but my wife and I have family in Fife…. and Christmas is coming.

Like most people in Scotland I have crossed the bridge many times. I have also walked and cycled across it a few times.

As part of my job, I have been to the top of the bridge’s north tower, visited the anchor chambers and also walked on the truss under the truss deck (no problems spotted!).  These visits took place over the period where the tolls were scrapped by the SNP (meaning the Scot Gov had to fund maintenance directly), the main cable dehumidification (ground breaking stuff) and the privatisation of bridge maintenance by the Scottish Government.

All this means I know the bridge well, but I still don’t know what a truss end link is! However I do know that as bridge maintenance was publicly run lots of details are in the public domain. What did I find?

February 2009: It is recognised that work on the truss is needed, but this is (correctly) deferred until the main cable dehumidification is complete:
The assessment work has now been completed and an independent check is being commissioned. Strengthening work on the truss has also been put back until there is confirmation on the outcome of the de-humidification scheme. However, work on the truss end links is scheduled to start in 2010/11 following completion of the independent check

May 2010: A tender for work on the truss end links is cancelled.

October 2012: Audit Scotland say of Forth Road Bridge funding from the SNP Government: “The budget for capital expenditure was cut significantly and a report highlighting the impact on the Capital Plan was noted by Board Members.”

August 2013: Work on the truss is planned on the truss ends:
As reported in June 2013, the Chief Engineer and Bridgemaster will bring three projects to tender during 2013/14. The projects that have been selected on the basis of criticality and affordability are; Main Cable Acoustic Monitoring, Truss End Linkages and Suspended Span Gantry Improvements. It is currently estimated that these three projects will cost £2.270m based on the current Capital Plan. This will represent the majority of the funds available for non-committed schemes and therefore it is recommended that a full risk assessment of all projects on site is carried out before the tenders are approved.

February 2014: Planned work “deferred”  due to Scottish Government budget cuts: During this second round of deferrals, the four projects detailed below were identified as having the highest estimated cost.  Therefore, these projects had to be considered in part or full for deferral in order to produce a significant reduction in the predicted deficit.  These projects were:

1. The Upgrading of the Main Cable Acoustic Monitoring Project 
2. Improvements to the Suspended Span Underdeck Gantries
3. Truss End Linkages Work
4. Improvements to the Suspended Span Underdeck Access System

Later:
Upgrading of the Main Cable Acoustic Monitoring Project and the Truss End Links Project were both considered vital to maintain the operational capacity of the bridge and were *retained in the programme*.

and importantly:
There is always a residual risk when maintenance works are deferred and it was noted that deferral of part or all of these projects does increase the risk to the long term structural integrity of the bridge and is likely to increase the actual cost of the works when they are eventually carried out.  

May 2015: Work is further delayed: The intention of the Authority was to carry out a trial repair on one tower leg and if successful, this repair would be carried out on the other three tower legs. However, due to issues with the quality of the existing tower steelwork; the difficulties of access and the existence of red lead paint, coupled with the loss of key management staff, the focus changed during the year to completing the trial on one tower leg before the end of May 2015.  If the trial is successful, a recommendation would be made to Transport Scotland that this work be continued post abolition of the Authority. If the repair trial is unsuccessful then full replacement will have to be considered by Transport Scotland.

 

 

 

 

Have the SNP ignored Audit Scotland and the BMA on Healthcare Inequality?

In the build up to the 2014 independence referendum we heard a lot from the nationalists  about inequality in Scotland and how “Westminster” was to blame. We heard frequently about how life expectancy in deprived areas was far lower than in affluent neighbourhoods. The nationalists were short on detail, but happily reassured Scots that independence was the answer.

Now, a year after the referendum, we find that the SNP Government provides GP practices in deprived areas  with less funding than their colleagues providing healthcare to middle class Scots. The difference in funding equates to around 2000 fewer appointment slots per year in each practice serving deprived communities.

The news will not be a surprise to some Scots,  in December 2012 it was reported that Audit Scotland had said “health inequalities were “long-standing and entrenched” throughout the country, and that “resources should be better targeted at those who require them most”. In response to the report the BMA urged the SNP Government to “use the unique relationship that GPs have with their patients and in their communities to target healthcare to those who need it most”.

In response to this damming criticism the SNP established a “taskforce”. Although this is welcome,  it is clear that the most basic recommendation made by Audit Scotland has not been delivered 3 years later – healthcare resources are not being  targeted where they are needed most.

Yet again, it appears we have a Government in Scotland which is long on rhetoric, but short on action.