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. 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 report 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 were 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.’

Thus does the spotlight land on 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 photo-op they should make her wait six hours in A&E then stick her in triage with the ten-pint Joe Fraziers and the teenage girls chucking up their first Bacardi Breezer. That’ll make a colourful backdrop for her soundbite on the evening news.

It’s tempting to write Robison off as incompetent and urge the First Minister to Hyslop her. Hyslopping is the practice of confining the most hapless ministers 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 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, the longest-serving since devolution. No one has made their mark on the NHS quite like Sturgeon. Nursing shortage? This was the minister who cut training places by 20 percent, 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/Liberal Democrat 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 shutter 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 of 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 still 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 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.

Despite receiving £13 billion 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.

Last week, Tory public health spokeswoman Annie Wells revealed that paramedics are called out to 50 alcohol-related emergencies every day. She wants to see the intoxicated treated at ‘temporary city units’ rather putting further strain on ambulances and emergency wards. This is exactly 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. No obvious candidate stands out and there are some who would be even worse.

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.

*****

Most MSPs will not be unduly alarmed by the news that Ukip wants to put them out of a job. As we report today, the party is preparing to call for abolition of the Scottish Parliament. Still, they have only one MEP — the delightfully batty David Coburn — and little hope for the future.

Nonetheless, it underscores how diminished Holyrood stands in the eyes of Unionist voters that Ukip reckons there’s mileage in reviving a policy it once dropped as too extreme.

The blame for this lies squarely with the SNP. It is they who have wasted so much parliamentary time — and public good will — pursuing a second independence referendum that even some Nationalist politicians think would be a bad idea.

The SNP’s penchant for picking fights with Westminster and acting on reserved matters has tested the patience of many voters. Most won’t agree with Ukip’s proposal at this stage but Holyrood should sit up and take notice all the same.

*****

Nicola Sturgeon jets off to Beijing on a five-day trip to boost Sino-Scottish relations. Human rights are expected to come up in discussions between the First Minister and Chinese politicians. A one-party state based on unquestioning loyalty to the leader and hostility to a free press, Scotland’s record is understood to be a concern for China.