Without injection of fresh initiative, prognosis for NHS looks very poor

THE Sturgeon economy is taking its toll on the rest of us but there’s one job she seems committed to saving. Health Secretary Shona Robison, personal friend and political ally of the First Minister, is resisting calls to resign over an NHS cash row.

Miss Robison replaced NHS Tayside’s management team after it emerged that charity funds were used to pay for a new IT system. Tayside has been one Wonga loan away from the workhouse for some time and is symptomatic of a health service in leaderless drift.

There is ample supporting evidence for that diagnosis. One in four GP surgeries reports doctor shortages, 2,500 nursing posts lie vacant, as do more than 400 consultant roles. Nine out of 14 health boards failed to achieve the emergency waiting times standard in February and one in ten planned operations was cancelled.

There is a 62-day waiting target for initial treatment of ten types of cancer. It is being met for none of them. Seven out of eight key performance indicators have been missed two years in a row and Audit Scotland concludes: ‘Scotland’s health is not improving and significant inequalities remain… there are warning signs that maintaining the quality of care is becoming increasingly difficult.’

Clueless

Thus does the spotlight land on Miss Robison, Scotland’s mildly clueless but mostly inoffensive Health Secretary. The best that can be said for her is that she means well; the worst, that this is what her meaning well looks like.

There is an old joke that the Queen thinks the whole world smells of paint because everywhere she goes the walls have just been given a fresh lick. Shona Robison thinks every NHS patient is whisked from reception to operating theatre in two minutes by 12 doctors with a BBC camera crew in tow.

The next time she pops in for a photoop they should make her wait six hours in A&E then stick her in triage with the tenpint Joe Fraziers and the teenage girls chucking up their first Bacardi Breezer.

It’s tempting to write Miss Robison off as incompetent and urge the First Minister to Hyslop her. Hyslopping is the practice of confining the most hapless minisof ters to the least critical portfolios, where they can be left to bungle things no one cares about. Named after Culture Secretary Fiona Hyslop, other beneficiaries include Angela Constance at Communities and Mike Russell, the minister for saying ‘Brexit’, ‘Westminster’ and ‘power grab’ in a different order every day.

Yet Miss Robison is not so much inept as ineffective and it is not entirely her fault. The Health Secretary for the first five years of SNP government was Nicola Sturgeon. No one has made their mark on the NHS quite like Miss Sturgeon. Nursing shortage? This was the minister who cut training places by 20 per cent, on whose watch health boards culled 2,000 jobs.

Nicola Sturgeon did for the NHS what that helicopter did for Holby A&E. She crash-landed in the portfolio, whirring with populist zeal, and sent staff diving for cover. The last Labour/Lib Dem administration didn’t have a perfect record but it was sometimes willing to take hard decisions – the kind that attract tough headlines and scary poll numbers.

The SNP tub-thumped its way into power in 2007 on the back of health board plans to shut A&E wards at Monklands and Ayr. These efficiency measures were based on evidence but that hardly mattered; there was an election to win.

These days, the SNP finds itself on the other side of the placards, decried for closing the children’s ward at the Royal Alexandra Hospital in Paisley.

Now, with karmic justice, they are the ones desperately pointing to the advice clinicians and getting nowhere. The simple slogans quietly dropped, the current Health Secretary speaks the cold, remote language of buzzwords. Parents who spend the night in casualty with a sick child don’t want another strategy, framework or performance review. They want their offspring seen promptly, not stuck for hours in a waiting room surrounded by closing-time brawlers. Patients put through the stress of cancelled operations are unimpressed by talk of capacity planning and learning lessons. If you are waiting to begin cancer treatment long past the target time, you will not be reassured to learn things are worse in Swansea or Southend.

But Miss Robison’s technocratic approach was always doomed to failure by the legacy of populism she and predecessor Alex Neil inherited. Nicola Sturgeon did not coin that miserable sigh, ‘It’s aye been this way’, but she did adopt it as her lodestar. No minister ever made so much noise doing so little, proudly boasting of all the reforms she was against. Yet, in this 70th anniversary year of the NHS’s founding, reform is what the leviathan requires.

Inefficient

Despite receiving £13billion a year, the Scottish NHS is inefficient, structurally shaky and not delivering for too many patients. We urgently need a grown-up debate on funding, provision and creating a more inclusive service that works in partnership with outside organisations to deliver healthcare.

Tory public health spokesman Annie Wells revealed paramedics are called out to 50 alcohol-related emergencies every day. She wants to see the intoxicated treated at ‘temporary city units’ rather than putting further strain on ambulances and emergency wards. This is the kind of bold thinking the NHS needs.

The Tayside scandal confirms that Shona Robison is struggling to cope. What is not obvious is whether there is anyone who could do a better job.

Miss Robison’s resignation is owed for a record of failure but her going would not improve the NHS overnight. The health service doesn’t need a new minister, it needs a new mindset with fresh ideas and the courage to be radical in the best interests of patients. Perhaps the SNP can provide that one day but the prognosis doesn’t look good.