There is much talk of ‘crisis’ in public services, particularly in local government and health, and with integration of health and social care. Budgets are cut, essential services for the more vulnerable in the community are adversely affected just when they need them most, staff morale is at an all-time low and valuable experience is being lost through workforce ‘re-modelling’ and ‘voluntary severance’.
Rather than bemoaning this undoubtedly serious situation, and believing there’s little prospect of a change in government austerity economics and fiscal policies, we need to ask i) ‘how can we mitigate the worst effects and offer some alternatives?’; and ii) ‘are Scotland’s public services following England’s into crisis?’
Taxpayers across Scotland are facing further cuts to public services after councils were warned that they face a black hole of half a billion pounds. A stark report from Audit Scotland last year forecast a shortfall of more than £550m in only two years as the gap between what local authorities spend and what they generate continues to widen. The Accounts Commission says the gap is £87m in this financial year, 2016-17. But it is expected to rise to £367m next year and then again to £553m in 2018-19.
The NHS funding gap is ‘just as real’ in Scotland as other parts of the UK, the BMA has warned. The gap means Scotland will not have enough money over the next five years to provide all the services patients require without ‘urgent and significant change’, including targets ‘skewing’ clinical priorities, GP shortages, excessive workloads and recruitment problems.
The impact of a growing, ageing population, which requires more support from health services as they manage multiple complex healthcare needs, is compounded by the pressure on health care teams to respond to these rising demands, with growing gaps in personnel and insufficient funding. The challenge for our politicians is to find a genuinely sustainable way forward for our NHS.
And, Scottish Government plans to shift healthcare from hospitals to the community, establish elective treatment centres and integrate health and social care, have come under criticism from Audit Scotland. However, Scotland’s integrated health and social care authorities are to be investigated by Scottish Parliament’s Health and Sport Committee, which will consult patients on whether integration authorities are doing enough to involve patients, carers, the third sector and other stakeholders in the design and future.
The new Integrated Joint Boards (IJBs) were launched last April to oversee smooth transitions between health and social care services. Official figures show a 5.1% reduction in bed days associated with people being unable to be discharged from hospital in 2016 compared with 2015, but how much of this is due to the IJBs is unclear. It’s an open secret that there have been conflicts within the boards between NHS officials and local councillors over how funding – which is channelled through the NHS – is spent. The IJBs also have a duty to involve stakeholders, and the committee has opened a consultation to hear from them how progress is going.
The Scottish Police Authority and Police Scotland have been hit with fresh criticism for failing to tackle budget pressures, as unions have criticised the balance of the workforce, as civilian staff are replaced by uniforms, taking cops of the streets.
Fewer houses are being built in Scotland than there used to be. Builders, property firms and politicians say this is driving up prices, making things hard for both renters and first-time buyers and leaving tens of thousands of people on council waiting lists for a home.
Minority governments have to learn quickly the value of co-operation. For the SNP, it’s been many years since it has had to make concessions in the Holyrood chamber to pass legislation. However, with the very serious threat of another election being called if the recent budget failed to pass, ministers had to get up to speed quickly. CoSLA, said reform of local government was ‘vitally important’. The Scottish Government said: ‘In this parliament we will introduce a bill that will refresh local democracy by giving more power to local communities. We will review the roles and responsibilities of local authorities with an aim to transform our democratic landscape, protect and renew public services and refresh the relationship between citizens, communities and councils’.
The Scottish Government promises more localism but drives towards more centralisation, evidenced by its reform agenda and through the re-emergence of ring-fencing of budgets. It gave councils the power to raise the basic rate of council tax by up to 3%. Bills have not gone up anywhere in Scotland since 2007. Now around a quarter of people will pay more regardless of their local council’s decisions, as bills in properties in Bands E to H will rise automatically through national changes to the way council tax is calculated which have been made by the Scottish Government.
But not all councils will opt to put up the basic rate of council tax by 3% costing a typical bill payer £3-4 a month. That councils raise currently only 15% of their expenditure contributes to the gearing effect and the relatively small amounts which can be raised, particularly in authorities with low asset base. We require a more fundamental cross-party review of general taxation and use of re-banding options available to the Scottish Government, rather than quick fix political slogans.
The Conservative Government’s austerity programme will result in around a further £2bn of cuts to Scotland’s public services. There is a broad consensus across Scotland that austerity is damaging to public services and the economy. As part of combating austerity, we should look at practical ways in which the Scottish Government, councils, health boards and other public bodies can mitigate the worst of the cuts to come. Every sensible mitigation measure government and public authorities can take reduces the number of job losses and damage to vital public services and the economy.
Our Combating Austerity campaign offers signposts to measures that would help combat austerity including: i) contract buyouts and/or refinancing of expensive PPP/PFI projects; ii) refinancing of council and other public bodies debt; iii) Imaginative use of council prudential borrowing and bonds; and iv) more efficient and effective use of local authority pension funds. More specific workforce measures would include: a) a Scottish Living Wage of £8.25 (£8.45 from 1 May 2017); b) fair working conditions; c) an effective voice for staff when negotiating with employers; d) secure working arrangements; and e) opportunities to advance your career, to develop knowledge and practice. This would lead to a competent, confident and valued workforce, delivering for our communities.
Mike Kirby is the Scottish Secretary of UNISON Scotland