The SNP’s NHS meltdown

When he’s not falling off his scooter like he’s auditioning for the role of Inspector Clouseau in the Pink Panther franchise, the gaffe-prone Scottish health minister, Humza Yousaf, is mired in a multitude of Scottish NHS crises.

This month saw Britain’s armed forces parachuted in to prop up the Scottish Ambulance Service. Nicola Sturgeon was forced to call on the military after distressed patients had to wait hours, and sometimes even days, for an ambulance – one of the most harrowing cases involved a frail Glasgow pensioner who died after waiting 40 hours for an ambulance to arrive.

Dig into the government statistics and the scale of the crisis facing the Scottish NHS is clear. At the end of June over 115,000 Scottish patients were waiting to be seen for the government’s eight ‘key’ diagnostics tests (such as CT scans, MRI scans and endoscopies) an increase of 9 per cent from the end of March, and 17 per cent higher than at the end of June 2020. The key diagnostics waiting list is 30 per cent higher than the 12-month average prior to the onset of the pandemic.

The latest emergency department performance figures meanwhile show four-hour performance reaching its lowest level since records began, with the number of patients delayed in accident and emergency continuing to rise steeply. Almost 30 per cent of people attending A&E in the week to September 12 had to wait more than four hours.

Commenting on the deteriorating situation earlier this month, Dr John Thomson, vice president of the Royal College of Emergency Medicine Scotland, said: ‘Among staff there is serious concern and low morale, winter is fast approaching and quite simply there is low confidence that our hospitals and staff are going to be able to cope.’

He added that ‘the entire health service is under severe strain’, and that ‘resourcing has not met demand for some time.’

Also this month, the Royal College of Nursing called on the Scottish government to take action to address nursing workforce shortages in health and social care, with the latest statistics from NHS Scotland registering the highest ever vacancy rate, with over 4,000 nursing posts unfilled.

The SNP’s response to these developments is to blame the Covid pandemic for all underperformance. But this only holds true to an extent. Examine the SNP’s approach to the NHS over the last ten years and there is plenty of evidence that today’s problems are at least exacerbated by policy mistakes in the past, if not directly caused by them.

Take, for instance, the actions of Nicola Sturgeon when she was health minister under Alex Salmond. Between 2009 and 2012, Sturgeon slashed the number of training places for nurses and midwives by more than 20 per cent, while health boards cut more than 2,000 nursing jobs.

A policy of cutting the number of hospital beds in Scotland has also been unhelpful. Public Health Scotland reports that in 2020-21 the average available staffed beds for acute specialties was 12,869, down 7 per cent over five years.

The Royal College of Emergency Medicine Scotland’s Dr Thomson, speaking to the BBC this month, estimated that Scotland needs an additional 1,000 beds to alleviate pressure on A&E departments.

And then there’s health spending as a priority. The Institute for Fiscal Studies has found that even though spending per head on public services is much higher in Scotland than in England, thanks to UK fiscal sharing, Scottish health spending per person now is just 3 per cent higher than in England, compared to 22 per cent before devolution. The chairman of the thinktank These Islands, Kevin Hague, illustrates the relative decline in health spending in his latest analysis of Government Expenditure and Revenue Scotland numbers (see graph below, with health spending line highlighted).

Even before the pandemic, only two out of eight key national waiting time targets were met by NHS Scotland in 2018-19, according to Audit Scotland. It is clear that these policy failures – going back years, including to Sturgeon’s time as health minister – created a health system ready to fail under stress. It is no surprise then to find that the post-pandemic future for Scotland’s NHS looks to be one of perpetual crisis.

Yousaf was handed the health and social care portfolio after May’s Holyrood election, having previously been responsible for justice. He no doubt views his new role as a stepping stone to becoming first minister. It might not be the boost to his career he hoped it would be.