Jobs pledge to all NHS staff was rash

When is a rise really a cut? Politicians are very sensitive about “the C word”, especially when elections are in the offing. Gordon Brown spent an entire summer avoiding it.

Today with a Conservative-led Government ruling Britain and a £149bn projected UK deficit this year, there is talk of cuts everywhere, including Scotland, which will learn its fate later this month.

Until now, one of the few exceptions to the general mood of gloom has been the NHS. In England and Wales, the health budget has been ring-fenced and, though Scotland’s Finance Secretary, John Swinney, prefers to talk of a “commitment to the NHS”, he has also promised to protect the budget and pass on to the NHS the automatic uplift (known as Barnett consequentials) Scotland will receive as a result of the rising NHS budget south of the border.

However, as the Health Secretary, Nicola Sturgeon, now concedes, that does not necessarily mean the Scottish health budget will rise in real terms. That is because, according to the Wanless Report, health service inflation runs at 4%. That is what the service needs each year to stand still, because of new drugs, new treatments and the rising number of elderly people. As the Barnett money will be substantially less than that, NHS budgets in Scotland are going to be squeezed. She also concedes that the NHS capital budget faces 20% cuts.

What is the easiest and fairest way to achieve cuts that are in the best interest of patients and society? The Herald has argued consistently that public services must use the new age of austerity to restructure, sharing backroom services and eliminating layers of management where possible. In The Herald last week, a former senior NHS administrator argued that NHS management has become flabby and self-serving and protecting these hierarchies merely risks putting unnecessary strain on social work and other local authority services that are equally vital to the health and wellbeing of the most vulnerable.

The Independent Budget Review, headed by Crawford Beveridge, went further. As health accounts for one-third of Holyrood’s budget, excluding the NHS from cuts exposes other spending departments to swingeing reductions of up to 25%.

Ms Sturgeon has jealously guarded her departmental budget and even wrote individually to all 170,000 NHS staff, telling them their jobs are safe.

In an interview in The Herald today, she argues that the distinction between frontline and backroom staff is often exaggerated, because both benefit patients. And she makes the point that structural change sometimes does not generate the intended savings. She is right on both counts.

She has made a rash pledge in a climate where numbers volunteering for redundancy have fallen, limiting her ability to slim down administrative departments. Being over-protective of the NHS, rather than spreading the pain more evenly, undermines attempts to bring health and local authority services together, as in Community Health and Care Partnerships.