Have Labour and the SNP called a truce in the cause of NHS reform?
heraldscotland, by Magnus Gardham
NHS Scotland has missed the government’s A&E waiting time target hours for 295 weeks on the trot. How do we know this apparently obscure fact? Because Holyrood’s opposition parties have been keeping count, of course.
On a quiet week it’s a banker for First Minister’s Questions. What is the First Minister doing to address the crisis in our accident and emergency departments? The fact the target to treat 98 per cent of patients inside four hours has been watered down to an interim measure (95 per cent will do for the time being) only adds to sense the health service is struggling badly. (For the record, 92.6 per cent of A&E patients were seen within four hours according to this week’s figures.)
Ministers set targets to drive improvement, raise standards and, ultimately, benefit patients, so they can hardly complain when they are held to account over them.
Each week government press officers dutifully put the best gloss they can on the figures. The latest failure was presented on Tuesday as "another slight improvement". Health Secretary Shona Robison insisted the figures showed "our NHS staff are continuing to work hard".
Each week opposition MSPs voice anger and vent frustration. This time round, they had the new Southern General Hospital in Glasgow in their sights after the figures showed only 83.2 per cent of A&E patients were treated on time.
There are signs these rituals might be changing. In a speech to MSPs, Labour’s health spokeswoman Jenny Marra agreed to support Ms Robison as she seeks to revise key NHS targets. She also backed calls for a public debate on the future of the health service, setting out proposals for a six month consultation exercise. She even – and SNP MSPs could hardly believe their ears at this – suggested the kind of public engagement seen during the independence referendum could be harnessed for a series of town hall meetings on the NHS up and down Scotland.
The change of tone did not come out of the blue. As The Herald has reported as part of its NHS: Time for Action campaign, health professionals are pressing harder than ever for reform.
Last week a report commissioned by the BMA’s Scottish consultants committee warned decisions were being driven increasingly on the basis of NHS budgets rather than medical need. At the root of it, said the report, were "politicians’ promises to the general public to meet increasing demands from an ageing population for a better quality of healthcare without being able to fully resource such promises".
The following day another report, from the medical and nursing royal colleges, said much the same thing: budgets were not keeping pace with the growing pressures on the NHS.
The report acknowledged the need for sweeping changes to the way health care is delivered and called for a public debate about what patients could and should expect from this much-loved institution.
Writing in The Herald, Ms Robison responded with a pledge to hold a comprehensive debate on the shape of the health service up to 2030.
She said she wanted to move "beyond short term demands" but acknowledged the need for public and political consensus to establish the "right" targets for the NHS and shift to a greater emphasis on primary rather than acute care.
Some believe that is the real problem at the Southern General. Poor A&E waiting times and other difficulties have been dismissed as teething troubles. The reality, experts reckon, is that the new hospital has been built for a health service that does not exist yet.
Ms Marra did not give the Scottish Government an easy time. She highlighted the missed targets and stressed it was her job to hold the government to account.
But in a rare admission for a politician, she acknowledged politics was hindering reform.
"I am sure we can all think on examples where populism or political opportunity has overridden the desire to do what we know is best for our NHS, and we all should take some collective responsibility for that," she told MSPs.
Is a new spirit of consensus politics emerging at Holyrood? It would probably be wise to reserve judgement until we’ve witnessed a few more First Minister’s Questions sessions. But Ms Marra’s speech was quietly striking. It will be interesting to see whether others on the Labour frontbench adopt her less confrontational approach.