At last, someone in the SNP is trying to cure the ills of the NHS – but more tax is not the answer

It’s been well documented that the people of scotland are fed up with Nicola sturgeon’s constant neglect of the day job in her role as First Minister.

this week, instead of sorting out the many crises piling up on her desk at Bute House, she’s chosen – much like Alex salmond might have done – to travel to the Us and lecture Americans on how wonderful scotland is under SNP control.

But her refusal to address domestic matters now appears to be annoying more than just opposition parties and voters. so astonished was he by her decision to cross the Atlantic to pontificate about scotland’s place in the world, back-bench MSP Alex Neil on Monday decided to take matters into his own hands.

Forget the First Minister, forget beleaguered Health secretary shona Robison and forget the inevitable frowns from Nationalist HQ, which can’t stand anyone within party ranks having the audacity to express their own point of view. Alex Neil was going to go his own way and did so by taking the unusual step of launching his own plan to save the NHs.

It was a bit like a football team’s kit man launching a strategy for how his club might win promotion, while the manager was on the other side of the world performing as a television pundit on tour.

that’s not to say some of what was said by Alex Neil – himself a former health secretary – wasn’t worthy of consideration. He’s one of the few SNP politicians whose independence of mind is matched by his fearlessness in speaking out. He’s right when he says the NHs needs proper funding and that the longer term challenges cannot be simply swept under the carpet, something the SNP has specialised in for almost a decade.

His points on developing a strategy which takes us into 2030 are sensible (even if that time frame is itself potentially too short-term), and his arguments on preventable illnesses, urgent measures to address staff shortages and a reform of primary care services all deserve to be taken seriously. But one idea of his that cannot be entertained is a further hike in taxation to provide more funding for the NHs, which is why his talk of a ‘ring-fenced, progressive national health and social care tax’ is very concerning.

In other words, it would mean that people right across the country would be allowed to keep less of the money they have earned. scotland is already the highest-taxed part of the UK thanks to SNP decision-making, and a new tax would make things worse for hard-working families.

But at least Alex Neil is trying to do something about the crisis facing the NHs, and it’s clear from Monday’s stunt that he was doing this because he thought his own government and party were either not doing enough or were doing the wrong thing.

the NHs is facing a perfect storm, and while funding will always be a key issue, many of the problems involve its structure and systems.

there are several things the scottish Government can do to address these problems.

Tampered

For a start, the NHs needs certainty to do its job, which is why we need immediate clarity about which services will change, and which won’t. Hints have been dropped about closures and ‘service redesign’ in different parts of the country, but ministers should come clean on precisely what they have in mind.

And for those services not at risk of change, a guarantee should be implemented that they will not be tampered with for at least five years, allowing staff the assurances they need to get on with the job.

the challenges being faced by accident and emergency wards across scotland are widely known. Many of those attending A&E do not have to be there, and that’s something even Alex Neil has previously acknowledged when he was on the front bench.

We want to see the Minor Ailments service expanded across scotland, as that would take the heat off not just A&E units but GP practices too. that could be done initially with an additional £10million a year in funding, and the benefits would soon be experienced.

Another problem which rears its head on a monthly basis is that of ‘delayed discharge’ – where a patient is physically fit to leave hospital, but has nowhere to go. this accounts for tens of thousands of bed days every month, and is miserable for the patients involved as well as being a nightmare for hospital managers, not to mention the higher costs entailed.

But improved informationsharing between the NHs, social care departments and the third sector – driven by a dedicated team – would start making inroads. Linked to this is the need for the NHs to make use of recent advances in technology, so that its digital systems can be improved and work in a joined-up way.

While there may be some merit in the Government’s plan to create elective-only units, this must not come at the expense of successful community hospital units which cover elective and acute work, and whose multipurpose nature allows consultants to take on a range of work, improving skills and maintaining local services.

With that in mind, we believe the impact of splitting up elective and acute care should be evaluated as a matter of urgency.

One thing that will never go away, particularly in the face of an increasing population which is living longer and with more complex health needs, is the financial challenge facing scotland’s health service.

By 2021, the scottish Conservatives want to see a shift in funding to preventative spending in primary, community and mental health care.

Our calls for increased funding for GPs have been heeded by the SNP, and that is welcome. Now mental health should get the transformative funding it needs to truly give it parity of esteem with physical health.

Of course all this needs to be paid for and, as it stands, health boards find it difficult enough to break even on a year-by-year basis.

Moving the NHs to threeyear funding cycles, rather than the chaotic annual arrangement, would give some breathing space to underpressure boards, and allow them to be more creative in managing their finances.

In terms of staff, the SNP has been shamed into publishing a national workforce plan later this year – but it’s woefully late in the day to be only now getting around to addressing the staffing crisis across the NHs, especially after a decade in charge.

Warnings

Better forward planning when it comes to staff would help reduce the hundreds of millions spent on bank and agency nurses, and the often extraordinary rates demanded by locum doctors.

Warnings were recently sounded about the cost of drug inflation, and how that could hamper the NHs. But instead of being a victim of these factors, the health service should use its purchasing power to its advantage.

Without undermining the structure of health boards, the scottish Government could centralise a select few specialised functions such as procurement and human resources, which would make significant efficiency savings.

the SNP cannot dodge this matter any longer. It trumpets itself as the guardian of the NHs – but after ten years in sole charge it’s been found badly wanting. And it’s no coincidence that the NHs has suffered while scotland’s Government focuses all its energy and brain power on the breakup of Britain.

that is a disgrace, and it is patients, visitors and staff who are paying the price.

the scottish Government has the levers to improve the NHs and make it work for everyone. that doesn’t mean it will be easy, but in future it shouldn’t be left to rogue backbenchers to be the only element of scotland’s governing party to come up with a plan for the future.