Scotland’s ever-changing health agenda

Aug 5 2008 by Dr Richard Simpson

HEALTH is one of the most difficult portfolios for any Scottish Government Minister to be in charge of. Apart from the medium to long term strategy there is the almost insatiable demand for new funding. But health above all others is a department where events can conspire to make life difficult.

The Labour coalition was driving forward an agenda of change to improve the outcomes for patients. But distinct from our colleagues in England who faced difficult challenges, Labour in Scotland chose an approach which was rooted in traditional public service values and only used the private sector where the NHS could not meet the targets set in the interests of patients.

We cancelled fundholding and commissioning and competition between “Trust” hospitals. We reduced the number of boards from 42 to 14. We set ourselves and the board and local authorities tough targets to get waiting times down and eliminate delayed discharges where patients, mainly vulnerable and elderly, waited in hospital more than six weeks for a community place. We achieved all of this and built and renewed more hospitals in our ten years than in any previous decade.

We doubled the funding for the NHS after 50 years of underfunding. But this modernisation was sometimes painful and the medical advice on which some decisions were based turned out to be more opinion than evidence.

Over the past year the new Government have made some popular decisions to reverse closures. They have emphasised a commitment to health and inequalities which is welcome. But in giving away over £300 million of tax revenues annually they have been unable to match Labour’s funding to health services in England or Wales. This will have an increasing effect year on year.

Meantime events are crowding in. Nicola Sturgeon is effective as a politician but she has repeatedly failed to ask the right questions and although the public and the press media nationally hold our politicians responsible this is not always reasonable. But what Government Ministers are responsible for is how they respond to and manage events.

For example patient records were found in the disused Strathmartins Hospital in December 2007. It took till May for a letter to go to all boards about data handling and the care needed when NHS property is sold or closed. But no order was issued to health boards to undertake a search of properties. So in July more records were found in Law Hospital. This is a position failure.

Another example was when the mandatory reporting of cases of c.difficile (hospital acquired infection) showed a rise in the last two quarters it was written off as “possibly seasonal” and no action was taken. Yet whilst cases in Scotland rose, in England the last quarter showed a drop of 32%. All these facts were available to the Cabinet and also they were warned by Labour in a debate that this bacteria was as important as MRSA. Despite these warnings it took a local newspaper – the Dumbarton and Vale of Leven Reporter to bring to light the shocking level of deaths associated with c.difficile (54 cases, 18 deaths). This is complacency.

As a result of effective opposition intervention we now have four separate reviews into ambulance service problems, a review of domiciliary oxygen supply contracting, on top of the c.difficile enquiry.

The easy short term approach is to halt or reverse change but if this means in the longer term poorer outcome for patients and families it is not in Scotland’s best interest.

Finally for those interested in politics can I recommend Holyrood’s “Festival of Politics as part of both Edinburgh and Carnegie Festivals – Annie Lennox is leading one event on HIV and Aids – details are at www.festivalofpolitics.org.uk