Lesley Riddoch: Scotland’s NHS is still a service to be proud of
Scotland’s NHS is still a caring, dependable, professional and public service, writes Lesley Riddoch
Some New Year’s resolutions have doubtless been discarded already – but here’s one we should try to keep in 2018. Next winter, when opposition politicians produce easy to reproduce statements of outrage about the state of the NHS in Scotland, why not resolve to compare conditions with the privatised, collapsing health service down south before passing judgment?
There was a big panic in December when figures showed only 81.1 per cent of people arriving at accident and emergency departments were seen within four hours despite the 95 per cent target. There’s no question that waiting in pain is a horrible experience. But let’s take a closer look at that statistic.
Firstly, Scotland often meets the 95 per cent A&E target while the NHS in England has not since 2013-14. Scotland’s health boards see 88 per cent of cancer patients in 62 days, which meets the English target of 85 per cent though not the higher Scottish target of 95 per cent. NHS England fails to meet either.
Secondly, there’s a small matter of weather. Other folk may not recall the week ending 17 December, but recovering from a hip replacement operation, it’s still vivid in my memory. It was the week of sheet ice, black ice and slippery pavements. As a result, Perth Royal Infirmary had to cope with 50 limb fractures sustained (mostly) by frail, older ladies requiring (on average) two week’s hospital care. With its beds full, PRI had to cancel elective surgery for a week.
In England, by contrast, the number of elective operations cancelled at the last minute by NHS trusts across 2017 was at a 15-year high. Scotland is doing fairly well by comparison – even though cancelled operations are always traumatic.
It’s also worth looking at what “waiting” really means. During A&E waits in Scotland, patients are generally triaged to assess their injuries and those with trivial complaints sent home, while the rest are reassured and put in priority order with the most serious receiving X-rays.
A six-hour wait during extreme weather conditions might still sound alarming but is it really a “total mismanagement of our Scottish NHS” as Scottish Tory health spokesman Miles Briggs claims? And would he suggest NHS Scotland should adopt the systems deployed by Conservative-controlled NHS England instead? I expect not, because conditions south of the Border are fairly shocking, if rarely mentioned during the annual complaintfest aimed at the Scottish Government.
First of all, it’s not uncommon for patients south of the Border to wait an hour in an ambulance or corridor before their A&E wait has even begun. Government figures show the number waiting in ambulances has doubled in two years and trebled in London. In December, a Freedom of Information request revealed the number of unexpected deaths in ambulances in England has doubled in four years and some trusts have “corridor nurses” to cope with patients lying three deep in corridors before admission to A&E.
Despite these extreme measures to delay things, A&E admissions in England are up by 12 per cent since 2012, compared with 4 per cent in Scotland. That’s largely attributed to the integration of health and social care north of the Border, which isn’t happening in England.
Secondly, while there was alarm in 2017 over news that NHS Highland had spent £200,000 on private cataract operations, one newspaper south of the Border reported thousands of patients were actually going blind as they waited for surgery in England. In August, the National Institute for Health and Care Excellence (NICE) told NHS trusts to abandon tests which let them refuse surgery until patients were nearly blind. NICE also stopped trusts offering surgery on one eye only which has forced desperate patients to have the second cataract removed privately. Even though new research shows women are 60 per cent less likely to fall after such surgery, saving the NHS millions.
The practice of health rationing in England simply followed guidance from local clinical commissioning groups (CCGS), which control budgets and decide who can be treated. Their judgment looks pretty poor – but things are set to get even worse.
Health professionals are taking legal action in January to stop Jeremy Hunt converting the NHS in England into a public/private enterprise. “Accountable Care Organisations” are set to replace CCGS and let private companies like Capita or Virgin run local health services instead. Campaigners want a judicial review, so that MPS can debate and stop these proposals. With all eyes on Brexit though, they may find it hard to get political and media attention.
Meanwhile, today is the tenth anniversary of Scotland’s decision to scrap parking charges at most hospitals, saving patients and NHS staff more than £25 million. This year, a Tory backbencher hopes his private members’ bill will do the same in England, where fees raked in £175 million for NHS trusts and private contractors last year – yet only 0.001 per cent of that income was spent on health.
In the realm of dental care it’s the same story. Childsmile means the NHS in Scotland saves £5m a year in treatment costs by offering children free toothbrushes, toothpaste and two fluoride varnish applications. The number of primary one children here with “no obvious decay” has risen from 54 per cent in 2006 to 68 per cent in 2014 and 92 per cent of children are registered with NHS dentists.
Meanwhile in England, the British Dental Association (BDA) says five million children fail to attend NHS dentists and extractions are surging because of £100 penalty fines levied by the UK government on patients who “inappropriately” claim free dental care. And of course there are free prescriptions in Scotland.
There are problems here, of course, and losing EU staff post-brexit will only make things worse. But the NHS in Scotland is still a caring, dependable, professional and public service when the same financial pressures in England have unravelled key aspects of public health care. So I’ve a New Year’s resolution for opposition politicians and political journalists – though I doubt they’ll be listening. Let’s keep the health debate in perspective during 2018 and recognise the value of a Scottish consensus behind a fully public NHS.