In unveiling his Programme for Government last week, the First Minister spoke for 34 minutes about his plans and priorities for Scotland. We have heard much since then about how this programme will repair relations between the Scottish Government and the business sector.
No one should be in any doubt that making Scotland a nation of enterprise and innovation is essential for economic growth, prosperity and the revenues needed to fund public services. Whether a government and a First Minister so fixated on social and cultural issues, and so lacking in business experience, will be able to achieve that is another matter.
If we are meant to be heartened by the emphasis placed on business in Humza Yousaf’s statement, what are we to make of his downplaying of other vital issues? One I have in mind is health. When he addressed MSPs, Mr Yousaf went 22 minutes – almost two-thirds of his speech – before mentioning the NHS.
The only thing worse than being identified as a priority by this Government is when they signal their utter indifference.
That’s not to say there was nothing in the health and social care announcements worth applauding. Guaranteeing a minimum wage of £12 an hour for those social care workers involved in direct care is a welcome, if belated, decision.
Complacency
There is an urgent need to improve the quality of social care in this country and that will only happen if we improve the pay and conditions of those who work on the frontline. An ageing population means this issue is only going to grow in importance.
When addressing MSPs, Mr Yousaf spoke for 22 minutes before mentioning the NHS
There was also the encouraging news that the independent living fund, which assists disabled people to live with autonomy, will be reopened. Additional support for women who suffer miscarriage, including certificates acknowledging their lost babies, will help expecting parents in this tragic situation.
In every other regard the Programme for Government displays a complacency towards the major challenges facing the NHS that borders on denial. The First Minister told us that Scotland has ‘the best-performing accident and emergency departments in the UK’. What he didn’t tell us is that only 73 per cent of patients are being seen at A&E within four hours. The Scottish Government’s own target says that figure should be 95 per cent.
While assuring us that Scotland’s NHS is ‘already making progress in recovering from the pandemic’, he failed to note that in February 2020, the last month before Covid-19 hit, 87 per cent were seen within the four-hour window. Sixteen months since NHS Scotland was taken out of Covid emergency footing and A&E performance is 14 percentage points shy of its pre-pandemic level, which itself was still missing the target.
The First Minister trumpeted news that ‘the number of people waiting more than 18 months for treatment has almost halved’. He left out the fact that almost a third of patients wait longer than 18 months, 4,000 more than before Covid.
Statistics are important but they only capture part of the story. Personal experience will trump data for many people. It won’t be enough for the NHS to improve. They will have to see it improve.
Improvement is not the word many would use to describe the NHS of late. They have found themselves up against endless waits on the telephone when trying to get a GP appointment. Securing an NHS dentist requires such rare luck that anyone managing it would be advised to next go out and buy a lottery ticket.
Some will know the anguish of having called an emergency ambulance for a loved one only to wait hours or be forced to make the journey to hospital by some other means. Others will have had a relative stuck in hospital because the necessary care package is not in place to allow them to be discharged.
Patients don’t just form opinions based on their own experiences and the experiences of those close to them. They also listen to professionals. They listen when Dr Alan Robertson, chairman of BMA Scotland’s consultants committee, says unfilled consultant posts are ‘worryingly high’ and that ‘the workforce is in crisis’.
They listen when Dr Andrew Buist, who heads up the BMA’s Scottish GP committee, warns of ‘a very bleak situation’ in GP services and says ‘many GPs fear the practices they work in are simply not sustainable in the long-term’.
Two nurses, stressed and tired, comfort one another after a stressful day attending to patients
The Programme for Government pledges to ‘improve access to general practitioner services’, but how exactly?
Over the past decade, the number of patients has increased by a quarter-million while the number of GP practices has dropped by 89. Almost one in ten practices are no longer accepting new patients. Thirty per cent of GPs say the future of their practice is precarious. A quarter intend to leave in the next two years. There are only two ways you can widen access to GP services: hire more GPs or shift a significant amount of practice workloads to others, be that in-house nurses and nurse practitioners or external pharmacists. Either way, we’re talking about a sizeable investment.
The First Minister will launch a ‘national centre for remote and rural health and care’. A very commendable idea but how exactly will it bring rural healthcare up to par with that provided in towns and cities? Rural Scotland is underserved in GP availability, access to pharmacy services and A&E treatment. The Government cannot say it wants to see people living in rural Scotland then fail to invest adequately in healthcare infrastructure.
Talk of ‘a new delivery plan for mental health and wellbeing’ is well and good but we’ve heard it all before. New plans, fresh strategies, improved approaches. Yet targets for both child and adult mental health services are still being missed.
Morass
This was Mr Yousaf’s first Programme for Government. It was his opportunity to tell us who he is, what he believes, and what his priorities are. As the former health secretary, with all the insights that role brings, he might have been expected to lay out a bold vision for the future.
A blueprint putting the service on a more solid footing.
Instead, we got the policy equivalent of a shrug. Some things will be done. More things will be hoped for. There will be input and aspirations but too little that is tangible on outcomes and metrics. It is as though, having been nothing much to write home about in the health brief, the First Minister has decided to steer clear of a political morass now that he’s at the head of the table. Is it just me or does this sound terribly familiar?
Another failed health secretary has moved onto bigger things and left the NHS behind in the dust. Another First Minister will talk about ‘our precious NHS’ but do precious little about it.
The difference this time is that the political landscape Mr Yousaf inherited from Nicola Sturgeon is a world away from the one she inherited from Alex Salmond. Back then, the SNP could rely on a rock-solid voter base of independence voters and others who simply preferred the Nationalists to any of the alternatives.
Independence supporters are coming to realise that Ms Sturgeon (ably assisted by Mr Yousaf) squandered one dream opportunity after another while the electoral winds were at the party’s back.
The weathervane is swinging in the opposite direction and to some voters those alternatives aren’t all that unpalatable any more.
There is now not only a political cost attached to failure on the NHS but an election due next year at which the voters can make the SNP pay the price.