Why Thatcher would have supported Swinney’s council cuts.

MTJS

COSLA may not support John Swinney’s funding settlement for Scotland’s local authorities,  but I hope he is reassured by the fact that Margret Thatcher would have.   The cuts the SNP are inflicting on public services show the same lack of respect for local democracy that she exhibited.

Just as Thatcher did, John Swinney is passing disproportionate cuts on to local authorities at a level which will have a direct impact on key public services like social care and education. Imagine the   fuss the SNP would create if the UK Government treated Holyrood in the same way?

In a move which also mirrors the “rate capping” Thatcher so loved, the SNP is again forcing its Council Tax Freeze on local authorities. This comes despite clear and unequivocal evidence from Naomi Eisenstadt, the SNP Government’s poverty advisor, that the Council Tax Freeze disproportionately benefits the wealthiest Scots and is funded by cutting the public services needed by the poorest in society.   Imagine the fuss the SNP would create if the UK Government forced such a regressive measure on Holyrood?

Of course, an individual local authority could decide to raise council tax to invest in reducing the attainment cap or improving social care. However, similar to the “grant penalties” Thatcher imposed against councils, Swinney has made it clear that any Local Authority which dares raise council tax to fund public services will be heavily fined.  Imagine the   fuss the SNP would create if the UK Government treated Holyrood in the same way?

There is one difference between Thatcher and Swinney. Thatcher was unsympathetic to those who relied heavily on local public services as she knew they were unlikely to vote for her. The SNP, on the other hand, take these votes for granted  in their effort to gain support for their independence nirvana amongst middle-class Scots.

As ever, the constitution must come before supporting the vulnerable in society.

 

 

 

 

 

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SNP & the Tories: Robbing Peter to Pay Paul in the Aberdeen City Deal

Ships in Aberdeen harbour.

It is rewarding to see the Tory and the SNP Governments working hand in glove for the benefit of the north east of Scotland. Perhaps we are better together after all?

Whilst the City Deal is recognition that there will be no “second oil boom” anytime soon, it will be a welcome boost to the Aberdeenshire economy. Nonetheless it is worth looking closely at what is being offered by our masters in Westminster and Holyrood.

Firstly it is notable that the £524m of funding is not immediately available, but will be drip-fed up until 2025.

The funding provided by David Cameron must be seen within the context of the cancelation of the Carbon Capture and Storage trial which may well have benefited the north east.

The bulk of the £254m provided by the SNP Government will be used to upgrade the rail track at Montrose. Alex Salmond actually committed to this, under pressure from Labour’s Lewis Macdonald MSP, in March 2014. At that time the then First Minister said he’d “actively take forward” the project.

It is also important to note that whilst the Scottish Government funding is welcome, the SNP are simultaneously cutting local authority spending in Aberdeen and Aberdeenshire by £25m in this coming year.

Not only are the SNP presenting existing infrastructure commitments as new projects, Peter is being robbed to pay Paul by both them and the Trories.

Alex Salmond’s Address to the Unco Guid

A week or two ago I posted a blog about Alex Salmond MSP/MP/Author/Columnist/Radio presenter. This was also published in The Scotsman as a letter. Today Mr Salmond replied. Below is my response.

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I feel obliged to respond to Mr Salmond’s letter addressed at me (letters, 26 January).  The fundamental point I was making in my “sad and sanctimonious” letter (18th January) was that the SNP’s Pete Wishart told Scotland that it was not possible to be an MP and have a second job. Mr Salmond clearly thinks otherwise – we can all agree on that.

As for Mr Salmond’s claim to have spoken 124 times in the Commons, alert readers will note that he made no mention of his work in Scotland’s Parliament. Despite drawing a Holyrood salary, he has hardly been seen there since May.

As for Mr Salmond’s donations to  the Mary Salmond Trust, these are documented on the Scottish Government’s OSCR website for those who wish to test the veracity of the points I made.

Lastly, in my letter I raised the issue of the company Mr Salmond has established to receive his publishing income and, as has been reported, reduce his tax liability. I note with interest that he did not respond to this point.

Why Scots owe Burns a debt of gratitude for the impact he has had, and continues to have, on our great country.

burns

I have to concede that I don’t know a great deal about Burns. I know he was born in 1759 in Alloway and died just 37 years later in Dumfries.  I know he wrote poems and songs, but that’s about it. So in drafting this blog I wanted to learn more about the man and how he has influenced modern Scotland. To do this we have to look at when Burns lived and his values.

Just 50 or so years before his birth, the act of union had taken place. Scotland had joined with England. England had 5 times the population and 36 times the wealth. Scotland did not have equal riches, but Scots equal partners. Amongst the benefits Scotland brought to the table was education. As well as a literate general population, we had a highly developed university system – five universities, to England’s two.

By the time Burns was born, Scotland was successfully combining its educated population with English gold to create the Scottish enlightenment. Indeed, he was to be a key part of this intellectual movement.   This movement, combined with our protestant work ethic, enabled Scotland to hit above its weight and become more affluent. However, much of the “hitting” took place in the Empire and focussed on tobacco and slavery.

We should not pretend that by the time of Burns’ birth that everyone was happy with the union in Scotland. After all, the 1715 Jacobite rebellion would have been within living memory and his parents would have lived through the 1745 rebellion. Indeed, his grandfather is likely to have lived through both uprisings (his DoB is unknown, but Burns’s father was born in 1721).

Given that Burns’ family no doubt discussed these events, it is tempting to wonder what he made of Scotland’s constitutional position both then and now. It is notable however that in over 600 works published by Burns there is hardly a mention of the Jacobite rebellion. His attachment to the Jacobite cause was purely sentimental, and he had no desire to see the restoration of the Stuart monarchy. Furthermore, as Alex Salmond once said, “No-one should ever try to pigeon-hole Burns into party politics because he was far too big for that”. Nonetheless, Mr Salmond did go on to suggest that Burns would have voted Yes in the referendum because “From tip to toe, Robert Burns was a 100% Scottish patriot” – as if one can’t be a patriotic Scot and oppose the will of Alex Salmond.

The problem Mr Salmond faced was that although he could extend the referendum franchise to 16 and 17 year olds, allowing the dead of the 18th century to vote was beyond even his abilities! Furthermore, we can’t imagine what Burns would make of Scotland today and our ruling class in Holyrood. More interesting than how Burns would have voted in the referendum is how he influenced politics today.

So what were Burns’ values? For the Burns family the 1745 rebellion coincided with his grandfather taking on the lease of a farm.  When the farm encountered financial problems just two years later, Burns’ father moved to Edinburgh where he worked for two years landscaping gardens in the area now known as “The Meadows”. In 1750 he moved to Ayrshire and worked as a gardener until 1786. He then became a head gardener and leased seven acres of land at Alloway where he built the cottage which was later the birthplace of Burns.

So Burns would have grown up in a household which knew what hard work was, but he would also have been familiar with the wealth of the laird. At the same time the world was also changing more in the second half of the 18th century than Scotland had in the first:

  1. Britain became the dominant power on earth.
  2. The slave trade began to crumble (Burns was almost part of it)
  3. America fought an 8 year war of independence (messy, but perhaps quicker than a “once in a lifetime” referendum).
  4. Australia was discovered (or perhaps rediscovered).
  5. The French revolution took place.

Just as the world was changing, so was Scotland:

  1. Wearing tartan and the kilt was again legal.
  2. The Forth-Clyde Canal was opened.
  3. Scotland’s first proper lighthouse was built.

In the 18th century the opening of the  Forth-Clyde Canal and the construction of lighthouse at Kinnaird Head would have been massive engineering endeavors. Due to good maintenance,  we still benefit them today.

Like many other Scots, Burns worked hard and sought a better life for himself. He moved from farmer, to mill worker to white collar tax collector. This experience and growing up on a farm would have shaped him more than anything and this is reflected in his works. Burns reports and reflects on the lives of ordinary Scots, and freely insults and attacks the privileged in society  – the clergy, the wealthy and  government employees like himself. On politicians he said, “all would rule, but none obey”.

Indeed his sympathies for Wallace, Bruce and the French Revolution were all rooted in his opposition if tyranny and subjugation of the poor.

Even if we look at a Burns poem which we learn at school, To a Mouse, we find that it offers more than meets the eye. On the surface it tells the story of a mouse whose home has been destroyed by a ploughman. However, is also a  depiction of how the ordinary man is equally vulnerable to external forces. As a tenant farmer, Burns was particularly aware that the best laid plans of mice and men may often go wrong. However, man suffers even more through worry than the mouse which apparently only lives in the moment.

It is this perspective that led to UNESCO declaring Burns the world’s first ‘people’s poet’ because he began the practice of writing poetry, prose and songs about the commonplace experiences of the poor.

People as diverse as Bob Dylan and Colin Fox, the SSP leader, claim Burns inspired them. I disagree with Fox on many issues, but I don’t doubt his commitment to fairness and equality.

But when we look at impact of Burns on society, Towering above both Fox and Dylan is Keir Hardie – the man who started the democratic revolution that delivered the NHS and the welfare state. Hardie said that he owed more to Burns “than any man alive or dead”. Indeed, Hardie rejected Marxism in favour of a humane and popular approach to politics that came out of his Christianity and the works of Burns. Referring to the ideas of humanity and equality found in the works of Burns, Hardie told a friend that “Burns point of view” was superior to a socialism of “German formulas” (Marx).

So in collusion, we in Scotland should be proud of the way Burns has influenced political thinking and his role in inspiring the likes of Hardie.  However, I would say that we should perhaps concern ourselves less about what Burns would have thought about Scottish independence  and more about his values and how they can continue to shape Scotland to meet the needs of ordinary Scots. The problem we face is that Scotland’s ruling political elite, and I include all the media in that,  find the constitutional politics more interesting than the job of making Scotland a fairer and more equal society.

Therefore, in toasting the immortal memory of Rabbie Burns next week we should  pay tribute not only to the passion and power of his work, but we must acknowledge that as Scots we owe him a debt of gratitude for impact he has had, and continues to have, on our great country.

 

Thanks to: Megan Coyer, Colin Fox, John Knox, Blair McDougal, Ralph McLean et al.

Oh, and I liked this:

 

Why Salmond is not a full-time MP.

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I have no doubt that Alex Salmond deserves £1,800 for appearing on the BBC’s “Have I got news for you”. The question is, where does he find the time?

On the 25th of February 2015, the SNP’s Pete Wishart MP said in parliament: “I believe that being a Member of Parliament is a full-time job.” He went on to say “No SNP Member has a second job, a directorship or a place on a company. Our responsibilities here are our sole concern and our only responsibility.”

Alex Salmond clearly puts himself above ordinary SNP MPs. As well as being paid by the BBC and as an MP, he also hosts a weekly radio show for LBC. In addition to this, he receives £1,641 per month as an SNP MSP.  In 2015 he recorded that he earned £27,000 for “articles and interviews” in the Dundee Courier and the Aberdeen Press and Journal over a 2 month period. In addition to this, he has income from Daily Record and The National. He also has considerable income from the books he has written and has recorded income of up to £12,500 for a speech. Whilst attending the “Prostate Cancer UK Scottish Seniors Golf Open Tournament” he accepted hospitality worth in excess of £1000.

We also know that Salmond refused to repay his £65,000 ‘resettlement grant’ he received when he voluntarily left the Commons in 2010 despite returning in 2015.

Mr Salmond does direct some of his income to a charity, including one he established in the name of his mother – The Mary Salmond Trust. The charity’s total income in 2014 was £4, but in 2015 this is reported to have risen to £7,848.

He also directs publishing and media income to a private company – The Chronicles Of Deer Limited.  Mr Salmond is the sole shareholder, but Tasmina Ahmed-Sheikh (a SNP MP) is a director. As yet, there are no published accounts but there have been repeated claims that the purpose of the company is to reduce Mr Salmond’s tax liabilities.

There is no suggestion that Mr Salmond is breaking the law, but it is clear that for him being an MP is not a full-time job.

 

Fact Checked – My SNP MSP’s Leaftet

GM

The SNP’s Gordon MacDonald has a habit of issuing misleading leaflets and his most recent one is no exception. Let’s look at some of his claims.

 

Claim #1: The SNP Government has invested £12 billion in the NHS.
Reality: We know that in real terms the SNP have cut NHS spending, whilst in England spending has increased. Put simply, the SNP are short-changing our NHS.

barnett

Claim #2: The NHS in Scotland now employs an extra 10,000 staff.
Reality: When the SNP were elected in 2007 the NHS had 131,094 members of staff. It now has 137,727, that’s an increase of 6633 (not 10,000). Since 2009 staff numbers have increased by 1.5% in Scotland, whilst in England the increase has been over double that – 3.5%:

workforce

Labour increased NHS Scotland’s workforce by 19.5%:

total workforce

Claim #3: The SNP have invested £900 million on transport.
Reality: Duelling the A9 is great news, but has Mr MacDonald seen the state of the roads in his constituency? Major thoroughfares resemble the surface of the moon as he voted to cut the council budget.

Claim #4: The SNP have maintained 1000 extra police officers.
Reality: Mr Macdonald is proud of this flagship policy. To maintain the police numbers and balance the budget, Police Scotland must cut administrative posts and have police officers take on more paperwork. This is not new – even before Police Scotland was formed the SNP were boasting that they’d appointed “1000 new officers”, but failed to mention that half these officers took the place of 972 sacked civilian workers. Unison’s George McIrvine: Police officers being paid around £35,000 a year are now doing the jobs previously performed by civilian specialists on £25,000.

Claim #5: The SNP have built or “refurbished” 526 Schools in Scotland since 2007.
Reality: This is great, but what is happening inside them? We now have 4,000 fewer teachers in Scotland. Numeracy is falling. Literacy is falling. Worst of all, after 9 years of an SNP Government, the gap between the richest and the poorest is getting wider.

Claim #6: If elected the SNP will build 50,000 affordable homes.
Reality: Shelter Scotland say 60,000 are needed and that’s what Labour would build.

 

It’s time for change
Whilst Mr Macdonald’s leaflet contains a few misleading statements, what is not there is more interesting. It contains nothing about what Mr Macdonald has done for Edinburgh Pentlands or what the Scottish Government has done for the area.

So why is he so quiet about his record? Perhaps it’s because parts of Mr Macdonald’s constituency have the highest burglary rate in Scotland, but he has not raised a single question about Police Scotland’s performance in Holyrood? Perhaps it’s because NHS Lothian is underfunded and overstretched, but he is doing nothing?

Edinburgh Pentlands does not need a “business as usual” MSP, it needs somebody who will fight to improve public services and ensure the poorest in the constituency get a fair deal.

 

 

 

Scottish Labour’s position on social housing.

social_housing_cropped__wide

With people saying silly things about Scottish Labour’s position on social housing today, I thought it was worth sharing the housing motion which was passed unanimously at conference:

Conference believes that everyone deserves a warm, secure home where individuals, families and communities can thrive and that a decent standard of housing is crucial to the development and well-being of children, the health of the nation and an efficient workforce.

Conference recognises the acute shortage of affordable housing across Scotland; that it is currently estimated by Shelter Scotland that there are over 150,000 households on local authority housing waiting lists; that the primary tenure for households in Scotland is still owner occupation, however 13% of households now live in the private rented sector which has more than doubled in the last ten years and notes the increase in the cost of rents; that according to the Scottish Government’s latest figures by the end of March 2015 there were 10,488 households in temporary accommodation in Scotland and there were more than 35,000 homeless applications in 2013/14; overall house building levels in Scotland are currently well below their 2007 peak levels and social housing completions have fallen by 44% from 2010 to 2014. Conference understands that of Scotland’s housing stock over 1 in 10 households in Scotland are affected by dampness, condensation or both, 940,000 are in fuel poverty and roughly 75,000 households are overcrowded.

Conference believes that this points to the clear failure of the Scottish Government to tackle Scotland’s housing crisis.

Conference calls on an incoming Scottish Labour Government to commit to backing Shelter Scotland’s for a radical programme to build more affordable and social rent homes, including co-operation as a model, council and third sector building; calls for a fair deal for private sector tenants through rent controls and adequate housing standards with enforcement powers.

 

159 words and some pictures in defence of Anne Begg (@annebegg) and David Leask (@LeaskyHT).

Dame-Anne-Begg

Yesterday The Herald reported that Anne Begg (the former Labour MP for Aberdeen South – above) had been bullied online after Wings over Scotland suggested she knowingly campaigned with a member of the National Front with full knowledge of who he was. Ugly stuff, but Anne Begg does concede in the article that online abuse is not unique to nationalists.

How did nationalists react to the article? Wings over Scotland called the original headline a “complete and utter lie”:

before

15 minutes after publication, The Herald changed the text to:

after

Yesterday morning Wings over Scotland tweeted this:

begg2

Later in the day he tweeted Anne Begg directly:

begg1Of course, the evidence does exist that Wings over Scotland’s acolytes did call Anne Begg a Nazi:

CYBcq9fWMAA_ro2

But what about Wings over Scotland? Did he call Anne Begg a Nazi? Could this be true? After Wings over Scotland tweeted me earlier today, an alert reader sent me this:

xdL4WIp0

It appears the offending tweet has now been deleted…

A hard look at how NHS Scotland is performing under the SNP.

NHS-Scotland-1024x677

The NHS saved my life. This did not involve blue flashing lights or lots of drama. After a series of consultations, I was diagnosed with “sick sinus syndrome” and a few weeks later I had a state-of-the-art pacemaker fitted. All the staff I interacted with between when I last saw my GP to when I was discharged from Edinburgh Royal Infirmary were utterly professional and I have huge respect for them all.

However, it was very clear that staff and systems in the NHS were stressed. The nurse who took me to theatre did so in her lunch break. I saw a doctor offer to take casework off an overloaded ECG specialist. On discharge I was asked to make an appointment with my GP practice to have my dressing changed 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.  All this was in the space of a few hours. 

These acts 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, but it was clear that they were stretched. Indeed, two days after my operation I read the news that only around a quarter of nurses feel that their department is sufficiently staffed.

Based on this experience, I wanted to write a blog about the NHS in Scotland and the challenges it faces. This is it.

 

Claim #1: The NHS is the best healthcare system in the world.
Yes, it is certainly one of the best! The UK NHS has been declared the world’s best healthcare system by the Commonwealth Fund, a Washington-based foundation which is respected around the world, who rated its care superior to countries which spend far more on health.

 

Claim #2: The NHS in Scotland is better than the NHS in England.
No! A comparative study in 2010 found that the NHS in England performed better than the devolved systems across the board. A similar independent study in 2014,  which included a wider range of performance measures, revealed that while there are few indicators on which a devolved country does better than England, the performance gap between England and Scotland has narrowed in recent years, but is still significant. One thing that stands out in this study is that deaths considered avoidable due to medical intervention are 20% higher in Scotland (see charts below – NE England is included as its demographics are closest to Scotland/Wales/Northern Ireland).

death

On the positive side, waiting times have fallen in Scotland to the extent that they are now comparable to England’s (see chart below as an example).

chart (2)

It is important to note that the English system performs better than Scotland’s despite our system having extra funding.

Claim #3: The Tories in Westminster are starving the NHS in Scotland of cash.
Nope, the NHS is devolved and Holyrood decides what Scotland spends on the NHS. During the independence referendum campaign the SNP’s Yes Scotland warned Scots that “more private money and less public funding” from Westminster on the health service would “automatically trigger cuts for Scotland” (see meme below).

nhs scotland

What the SNP didn’t say was that the Tories were increasing NHS spending and the SNP was not passing it on. The impartial IFS found that the Tories had increased NHS spending by 4.4% and, although this would have resulted in extra Barnett money, the SNP cut funding in Scotland by 1.2% (see table below).

barnett

Looking at spending per capita also raises questions (see chart below). In England spending on health has increased in recent years, but in Scotland it has fallen by £51 per person.

chart

As recently as October 2015 Audit Scotland said that NHS funding in Scotland for day-to-day services and new hospital buildings had fallen by 0.7% in real terms over the last six years:

“Tightening budgets combined with rising costs, higher demand for services, increasingly demanding targets and standards, and growing staff vacancies mean the NHS will not be able to continue to provide services in the way it currently does. Together, these pressures signal that fundamental changes and new ways to deliver healthcare in Scotland are required now.”

 

Claim #4: The SNP have increased the number of nurses in NHS Scotland.
Yes, but only after cutting them. When the SNP entered government, NHS Scotland had ~57,000 nurses and midwives (increased by Labour from 53,000 in 2002 – a 7.5% rise). From 2008 to 2012, the SNP progressively cut the number of nurses to just over 56,000. It was not until 2013 that the number of nurses reached the level Labour had achieved. There are now ~59,000 nurses in Scotland – a 3.7% rise over 9 years (see chart below).

nurses

 

Claim #5: UK immigration policy is stopping Scotland recruiting the nurses it needs.
Why does Scotland need to import nurses from outside the EU which have been trained at great expense to their own government?

The answer is simple – Nicola Sturgeon cut nurse training in Scotland when she was the Scottish Health Secretary. She cut the number of nurses entering training over three years from 3,400 to just 2,700 in 2012/13 (see chart below), claiming that her cuts reflected “emerging employment trends in NHS Scotland”. Indeed, when challenged by the RCN in 2012, Ms Sturgeon claimed her cuts were the “sensible way forward”.  At the time, the RCN was clear that the cuts would result in a real risk that there would “not be enough professionally qualified nurses graduating” between 2015-18.

Student Nurse

Events have shown that Ms Sturgeon should have listened to the RCN. In Scotland 75% of nurses think that wards are understaffed and 10% can’t take time away from their ward to undertake mandatory training. In January 2015 we found that stress-related sick days among nurses in Scotland had risen by 34%. We have also seen that understaffing is at the core of the failure of the A&E service to meet waiting time targets in Scotland.

 

Claim #6: The Scottish Government have a strategy to cut healthcare inequality.
Yes, it has a strategy! This is how Audit Scotland described it in 2012: “National strategies which aim to improve health and reduce health inequalities have so far shown limited evidence of impact”.

Audit Scotland 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 was welcome, it is clear that the most basic recommendation made by Audit Scotland has not been delivered 3 years later – healthcare resources are still not being  targeted where they are needed most.

In late 2015 Audit Scotland noted that GP practices in deprived areas had 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.

 

Claim #7: PFI/PPP was bad for the NHS and it is good that the SNP abandoned it.
T
he SNP don’t like to admit it, but they are big fans of PFI. They know it is controversial, so they call it “Non-Profit Distribution” – don’t be fooled by the name, it is PFI.  In Edinburgh, the new Sick Kids Hospital and the Scottish National Blood Transfusion Service facility are being procured by the SNP using NPD/PFI. Indeed, just a few weeks ago John Swinney announced a new batch of projects which will be procured via NPD/PFI.

 

Claim #8: The SNP have stopped the backdoor privatisation of the NHS.
This is bonkers. We know that about £82 million was spent by the SNP Government on private health firms last year, compared with £75.9 million the year before and £58m in 2006-7 when the SNP came to power. This increase comes after the First Minister Nicola Sturgeon’s pledge to save Scotland from the “creeping privatisation” of the NHS south of the border.

This does not include the involvement of the private sector in social care. One business which has benefited from this is Balhousie Care Group, Scotland’s largest private residential care home provider. The Chairman and founder is Tony Banks, a millionaire who is a key player in the independence movement.

 

Claim #9: A&E Waiting times are being reduced.
Correct, but the waiting time target target is still being missed. At the beginning of 2015 is was clear that the SNP had lost control of A&E waiting times. After sustained pressure from Scottish Labour, the SNP started taking the issue seriously. Nonetheless, the most recent data shows that only 93.7% of patients were seen within 4 hours – the target is 95% (see chart below). In England the situation is marginally better with 93.3% (there may be differences in how the data is collected/presented).

AandE

Personally, I find the obsession the Scottish establishment has with A&E waiting times unhelpful. It is a really important benchmark, but focussing solely on it is distracting. For example, is it not worse that so many children & young people that have had to wait more than 18 weeks to see a mental health specialist? The 18 week target is intolerably long and failing to hit it is unacceptable (see chart below).

mental.png

Claim #10: By tackling delayed discharge, there will be fewer cancelled operations.
C
orrect, but the SNP are not delivering the progress they promised. Cancelled NHS Scotland operations were in the news recently – there were thousands of cancelations in 2015 (see chart below). Whilst this makes a change from reports of A&E waiting time targets being missed, the two issues are related. Both are linked to “delayed discharge” (AKA bed blocking).

Cancelled

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 claimed to be 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 2015. How did she do?

The situation up to October  was pretty poor (see chart below). 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.

bed blockers

Claim #11: OK, there are problems in NHS Scotland but at least it is better than when Labour ran it.
Labour have not been in power since 2007. Over that time there have been real improvements in medical science, clinical processes and treatments. If nothing else, we now have a much better understanding of how to eliminate hospital acquired infections. We must give the SNP credit for taking advantage of these innovations, but we must also be willing to accept that other parties would have done the same.

We also must accept that the reforms Labour enacted as part of the National Health Service Reform (Scotland) Act 2004 led to some short-term problems with service delivery, but ultimately had NHS Scotland on a much stronger footing by the time the SNP took office. Indeed, in 2014 the Nuffield Foundation had this to say about the impact of these reforms on waiting times:

“In terms of whether Scotland’s greater emphasis since 2005 on targets and performance management has had an impact, it appears that Scotland’s hospital waiting times now match England’s, suggesting, but not proving, a positive effect.”

Claim #12: Yes, but no matter how bad NHS Scotland is it’s better than Labour’s NHS Wales.
Firstly, the Welsh Assembly does not have the same range of powers as Scotland’s Parliament. Secondly, the Barnett formula ensures Scotland has higher per capita funding than Wales. Nonetheless, it is often claimed by the SNP that NHS Wales is inferior to NHS Scotland. Why is this?

I can’t answer this fully, but others have considered it. The Nuffield Foundation say:

“Across a number of measures of performance, since 2006” NHS Wales “has improved to a similar level as England”, however, “common procedures in Wales indicate a lengthening of waiting times after a period of improvement, contrary to trends in England and Scotland.”

This is because the Welsh Government has made different spending decisions and has placed greater emphasis on prevention (the chart below shows the number of GPs), public health and social care. The shift of money from healthcare to social care has meant that delayed discharge and A&E overload have not been the issue they have been elsewhere in the UK.

chart (3)

It appears that in Wales longer waiting times are accepted as a price worth paying for better social care and preventative healthcare. Accepting that, we can’t simply focus on waiting times when comparing NHS Scotland with the Welsh system. To emphasis this point, the chart below shows satisfaction ratings.

chart (4)

 

Conclusion.
NHS Scotland is not perfect, but it is not a shambles either. However, if it is to be there when we need it, we all have a duty to be honest with ourselves about how it is performing. This means that problems must be neither exaggerated nor swept under the carpet. Simply ignoring failures or boasting that what we have is very marginally better than NHS England/Wales is not good enough. We all have to think about what kind of NHS we want and what level of funding it deserves.

When judging the performance of the NHS, we can’t simply focus on a single KPI (e.g. A&E waiting times), but look at healthcare in a much more holistic way. We have to understand the link between GP provision, bed blocking, social care and the demands placed on A&E services.

Labour have been clear that their priority would be to take the pressure off the NHS by investing in social care. The Public Bodies (Joint Working) (Scotland) Act 2014 is clearly a mechanism for doing this as it will demand our Local Authorities work closer with the NHS to deliver social care. However, as both are underfunded there is concern that service delivery will actually be harmed.  Nonetheless, there is huge potential to place much more emphasis on preventative healthcare in Scotland. A good start may be for the SNP Government to publish updated national social care standards and for all the parties in Scotland to bring forward proposals on how they can be delivered.