Party games for Scotland’s NHS

The SNP plans to introduce free prescriptions just before this year’s election, while Labour wants to merge health and social care

Election years are not good times to expect detailed pictures of party policy on healthcare. As they seek to engage with the electorate political parties inevitably opt for a broader-brush approach. 2011 is election year in Scotland – and the incumbent Scottish Government and its opponents have already begun covering their canvases.

The backdrop is not aesthetically pleasing. Although the Scottish National Party made great play of “ring-fencing” the health budget in its recent spending statement, Audit Scotland believes it will contract for the next six years. And with demand for services projected to carry on rising, it’s not difficult to see tensions developing between policymakers and frontline staff.
 
Indeed, Dr Brian Keighley, chairman of the British Medical Association in Scotland, was pretty blunt in his New Year message. He accused the governing classes of indulging in a “quick fix to see politicians through the next elections”, but which would instead “have a long term and persistent damaging impact on patient care”. For a service “only being held together by goodwill”, he added for good measure, staff were “inevitably going to struggle” to maintain standards.
 
“The government is playing a dangerous game with the medical profession,” said Dr Keighley. “Pay freezes, attacks on the contractual rights of hospital doctors, threats to pensions, the halting of the distinction awards scheme for highest achieving consultants and the ever-increasing workload being dumped, without resource, on general practice, is driving the government and doctors apart at a time when partnership is required.”

The SNP-controlled Scottish Government prefers to paint a rosier picture of the year ahead. “The Scottish National Health Service is safe in our hands” was the mantra of health secretary Nicola Sturgeon at last autumn’s SNP conference. That commitment, she added, would also be “reflected in the budget decisions we take”.

Total NHS funding is – at least on the surface – not an election issue. The budget for England was protected by UK chancellor George Osborne in his Budget and subsequent Comprehensive Spending Review, while John Swinney, the Scottish finance secretary, has committed to “passing on” the resulting consequentials (under the impenetrable Barnett Formula) in Scotland. In his own budget at the end of last year, Swinney also promised an additional £280m of “resource funding” north of the border.

This supports a clear SNP strategy of contrasting its health record since coming to power in 2007 with that of Labour and, even more potently, what’s happening south of the border as a result of the Conservative-led coalition. Nicola Sturgeon will constantly remind voters that it was she who saved accident and emergency units from the Labour axe, she who is following Wales and Northern Ireland in phasing out prescription charges in Scotland – currently £3 an item and due for total abolition in April – and she who has protected “our publicly-funded, publicly-delivered NHS”.

Social care, meet health

Labour, Scotland’s largest opposition party, is busy applying dark hues and stormy skies; only its victory in May, it argues, will add a splash of colour. In the meantime, its health spokespeople will invoke old masters like Nye Bevan, while accusing the SNP of cutting the health service by stealth.

The party does have one big idea: merging health and social care in order to create a “national care service” within the NHS, in the fashion of Northern Ireland, ensuring that “one organisation, one budget and one focus” (the person needing care) will remove what Labour says is a postcode lottery under the SNP. Scotland’s 22 health boards would also be streamlined.

BMA Scotland’s Dr Keighley clearly does not care for the pictures that are emerging. “An honest debate is needed in this election campaign,” he told Guardian Healthcare. “Our politicians need to recognise the reality of the choices facing NHS boards and cannot afford to make unrealistic commitments to secure votes.

“Doctors are committed to an NHS that is properly resourced, comprehensive, free at the point of delivery and provides equal access for all,” he added. “These are the principles upon which the NHS was based and upon which it must continue. However, the range and level of services available now are more comprehensive and complex and patient expectations are higher. To protect the principle of universal free healthcare, politicians must lead an open and honest debate with the public about what the NHS can and cannot deliver.”

BMA Scotland has published its own manifesto as a contribution to that “honest debate”, but only after 5 May – when Scots voters go to the polls – will the full picture emerge. Only then will politicians feel confident enough to cast off electoral expediency and get on with the job of seeing Scotland’s NHS through what’s likely to be a difficult year, and years, ahead.