The state of the health of our nation? Not great and not getting better after the election

Dave Watson is the secretary of the Socialist Health Association Scotland.

There are plenty of new faces in the Scottish Parliament, but will they make any difference to the nation’s health? Even a pandemic that has killed more than 10,000 people in Scotland and has driven 25,000 to the mental health helpline did not put health at the centre of the debate. That is one of the worst outcomes in Europe, but when the comparison is with bungling Boris Johnson, the First Minister looks at least competent. The ‘mistake’ of discharging vulnerable elderly people into care homes at considerable cost to life didn’t dent this perception.

When health did get some attention, it was the NHS that was debated. In fairness, it is hard to criticise politicians for this as it always tops the voter’s health concerns. Almost everyone relies on this universal service, so everyone cares about it. In many ways, the NHS is a victim of its own success.

Lots of big numbers have been bandied about along with commitments to ‘support and renew our NHS as it recovers from COVID-19’ (SNP Manifesto). There is a genuine challenge for the NHS as it attempts to get back to normal. Over 100,000 patients are waiting for a critical diagnostic test, including cancer, and planned operations have dropped by 35% (Public Health Scotland, February 2021). The British Medical Association (BMA) and others have warned that the actual consultant vacancy rate is just over 15%, with nearly half of senior staff planning to retire in the next five years. For other NHS staff, the exceptional effort and trauma caused by COVID-19 has left them exhausted and will have a long-term impact on their health and wellbeing.

The promised 20% increase to NHS funding over five years sounds impressive, but at £500m a year, it is little more than a catch up from the £479m increase in 2016/17. As the Institute for Fiscal Studies analysis (April 2021) of the Scottish Government’s spending plans shows, it has not allocated the full Barnett ‘consequentials’ to the NHS. The difference in spending between Scotland and England has shrunk from 22% in 1999/00 to just 3% in 2019/20. This is not necessarily bad if the money was allocated to preventative spending in areas that impact Scotland’s persistent health inequalities. A point I will return to.

Other NHS reforms in the SNP manifesto got less attention. Abolishing dental charges at the cost of around £75m is a welcome reform, ending the last remaining routine care charge. However, dental services will take a long time to recover from the pandemic with the growing use of private care to access care. This should be an opportunity to expand NHS dentistry services, calling time on the small business model. This was in the Scottish Labour manifesto, along with a commitment to integrate GP services into the NHS.

The SNP manifesto also includes a commitment to ‘review the number, structure and regulation of health boards … to remove unwarranted duplication of functions and make best use of the public purse.’ This was a previous manifesto commitment, but nothing happened. It is achievable for acute services, but the barrier is community services. The creation of a National Care Service may be the opportunity to remove that barrier.

One positive development was the attention all the political parties gave to mental health services. Increasing spending to 10% of the frontline NHS budget would be an important step forward, along with doubling the spending on Child and Adolescent Mental Health Services (CAMHS) and more preventative action. The scandal of drug deaths in Scotland has given greater focus to the issue, with promises of long-term funding. Still, most parties shied away from radical action as it requires the combination of devolved and reserved powers.

There was also a near consensus that social care needs to be reformed. There is a now clear majority in Parliament for creating a National Care Service with national collective bargaining. The debate will be about the degree of centralisation involved and funding. The SNP funding commitment barely does more than plug the funding gap and certainly won’t cover the necessary increase in care workers pay.

Less positive was the minimal attention given to Scotland’s deteriorating health inequalities. For SHA Scotland, this should be the biggest health priority. Professor Harry Burns attempted to insert this issue into the election debate (Herald 21 April 2021), highlighting the £4bn cost to the NHS Scotland in dealing with illnesses that can be directly linked to poverty and inequality. As he said: ‘Spending money to support struggling families will save billions across the life course. That is what this election should be about.’

Sadly, it wasn’t. The SNP manifesto barely mentions it, not surprising given their record in government, which has seen missed key targets on housing, fuel poverty and child poverty. Only Scottish Labour put increasing healthy life expectancy as their main health and care ‘national mission’. This demonstrates that we have much to do in persuading the wider public and then politicians that inequality is not just bad for the poor but also impacts our economy and society.

Overall, the election campaign did little to indicate that the new, sixth Scottish Parliament is prepared to take the radical action necessary to tackle Scotland’s pressing health issues. A few tweaks appear to be the limit of our national ambition.

Dave Watson is the secretary of the Socialist Health Association Scotland (