Proceed with caution on reform agenda

We are constantly told about the straitened state of public finances in Scotland. Following the banking crash of 2008, austerity became the overarching political mantra in the UK.

Austerity may be the politics of the past now but that does not mean that public bodies, such as the NHS, can suddenly be profligate with public cash.

That debate was again to the fore at Holyrood yesterday after Scotland’s Auditor General Caroline Gardner warned MSPS of the significant challenges faced by the NHS Scotland in recruiting and retaining talent.

Former Scottish health secretary Alex Neil immediately jumped into the fray, suggesting there was a need for a fundamental review of how the service operates.

His point regards duplication of effort in Scotland’s multiple health authorities – and the costs such a set-up entails – is salient, although no more so now than when Mr Neil was in a position to do something about it.

However, should a root and branch review of the NHS in Scotland come down the line, it makes sense that the spotlight will eventually fall on other seemingly unwieldy structures such as Scotland’s 32 local authorities.

Taxpayers are right to expect that public funds are spent wisely and streamlining services may make sense on paper.

Managing services from a hub in the central belt may add up on a spreadsheet, but it may not make practical sense.

Reformers should proceed with caution.