It is time to take the NHS out of political control. The political management of our health service doesn’t work and ultimately sabotages the NHS.
This winter the NHS on both sides of the border has crumpled under the weight of phlegm. The First Minister, Nicola Sturgeon, has apologised for the mess and a row has broken out as to whether cancelling operations is a sign of being prepared or being out of control.
It is not just that every winter is turning into an ‘NHS crisis’ moment, but every season. Our expectation of what is a good service gets ever lowered as we grow used to GPs too busy to see us, long waiting lists and surly nurses. It is obligatory in any NHS article to note that many of the staff are wonderful – they are – but many are not, clearly exhausted by long shifts and endless make-do.
The NHS in Scotland is working to the same budget – in real terms – as it was in 2010. All those protestations about ‘extra’ money from politicians amount to very little. The UK has been spending less on health year on year for nearly a decade. The budget increases are falling behind the rate of inflation.
The debate over who gives the NHS the most between political parties is the wrong argument – it is like people competing to bring a bucket to a drought, when what is needed is needed is a flood. The real discussion we need is: are we prepared to pay the real cost for health.
In cash terms the NHS budget in Scotland has gone from £10 billion in 2010 to around £13 billion in 2018. The Institute for Fiscal Studies notes that the average NHS budget increase for most of its history has been 4% per annum. Had the Scottish NHS budget stayed on that course, growing at 4% above inflation, It would now be somewhere around £15bn or £16bn.
The problem with health is that it has succeeded. Not only do we live far longer but we can treat far more illnesses, which is the real cost. The Office for Budget Responsibility says that four fifths of higher health spending is because of advances in health care – we are getting better all the time at health. Look at the new BBC documentary, Surgeons, which is about procedures once thought impossible.
We pay the real cost for broadband and electricity – enough for suppliers to walk away with large profits. We pay the real costs for water and rail – our money covers the service. But we do not pay the real costs for the NHS – in fact, we shortchange it year in and year out.
The problem lies partly in cost but also in the structure. The NHS in Scotland is run by a small cabal of mutually self-dependent officials. The Chief Executive of NHS Scotland, Paul Gray, is a career civil servant who works in the same building as the health minister and the finance minister, both elected politicians.
It is in the interests of the chief executive and the ministers to work in cahoots. It gives the impression of stable government if problems are settled in quite whispers in St Andrew’s House.
The point of devolution was to provide democratic scrutiny to this style of golf club government but it has failed. The failure is partly because everyone is so in thrall to the NHS it is being killed by kindness – health committees are not places of ferocious scrutiny. The ministers and chief executive are coached in the same party line by the same officials.
Health practitioners are all on the public payroll, a fact which holds their tongue. And the majority of the committee are from the government party, spouting the same slogans as the ministers and the chief executive.
The consequence is that we do not have a transparent debate about the state of our NHS or clarity on what’s wrong and what’s needed to fix it.
It would be better if an independent NHS made an annual request for funds, much as Scottish Water does. This would be assessed by a regulator and the parliament could then vote on how much money is given. If parliament should give less, then so be it, but at least the people can see where the blame lies.
It would be far better if the NHS was independent of government, an arms length public agency committed to the core principle of free, universal health care, but one which can argue its own corner without compromise. This has nothing to do with privatisation or introducing charges. It has everything to do with those principles being independently defended by the staff of the NHS.
Detaching the NHS from short-term, non-expert, budget-juggling politicians and giving it a long-term strategy based on a reliable funding stream is a natural evolution for the much-loved institution, giving it independence.
Our problem is we confuse the NHS with health – the NHS is a utility which fixes health problems. We should expect it to work well, not perform miracles.