Trying to catch up with press releases and emails after a week away has suddenly become a lot easier, thanks to Scottish Labour. Handily on Sunday (perhaps a name for a weekly DIY mag?) the party’s press machine whirred into action with a summary of all that had been “disastrous” in health the previous week.
The charge sheet was impressive: a failure to get a handle on “blanket-gate”, with the shortage apparently now having hit kids’ covers; critical staffing levels at Scotland’s specialist paediatric cardiac unit; a care homes drugs scandal; norovirus outbreaks closing 20 hospital wards – and, as Labour puts it, “continuing questions over the SNP’s hidden waiting lists”.
It’s almost too much for the brain to take in – a bit like being told there’s a choice of 10 puddings, most of which you really, really like, and only being allowed to sample one.
But, from the sweet spread on offer, I’m plumping for the “continuing questions” over hidden waiting times. To be fair, the main reason that the subject was raised last week was a debate led by Labour’s own health spokeswoman Jackie Baillie in the Scottish Parliament on Thursday morning – which rather begs the question of whether you can legitimately refer to the questioning continuing when you are, in fact, the questioner. But leaving that to one side, does Ms Baillie have a point? And, assuming she does, and questions are continuing, will any of this stick to the health secretary?
To recap, NHS Lothian has been manipulating waiting lists and has been found out. Health secretary Nicola Sturgeon says the problem is confined to Lothian (whose chief executive coincidentally resigned, ahead of a report which found the board bowed by a bullying management culture); Labour says it’s more widespread than that.
Specifically, Ms Baillie says that numbers of patients removed from the waiting time guarantee are up three-fold in NHS Ayrshire & Arran and NHS Fife; four-fold in NHS Greater Glasgow and Clyde and NHS Lanarkshire; and a stonking five-fold in NHS Grampian. That sounds like quite a lot, really, and would seem to back Audit Scotland’s point that “there is evidence pointing to an inappropriate use of this code”.
We’ll have to wait until the autumn for Audit Scotland’s own report into the management of waiting times to find out if the practices at NHS Lothian were more widespread. But even if they are, is it fair for Labour to label it the “SNP’s hidden waiting lists”?
Health boards – and trusts previously – have long been creative, shall we say, about meeting centrally set targets; this was the case before devolution, was the case under successive Labour/Lib Dem administrations, and is likely still the case under the current regime. The golden rule is generally that if one lot is doing something, others may be too.
I’m reminded of financial troubles in Tayside over a decade ago, where it turned out that NHS bodies had been using various strategies, including spending non-recurring money (eg one-off cash from selling off assets) to meet financial break-even which, at the time, was the priority national target. There were other problems too – including a lack of effective oversight and communication from the (Labour-led) centre, but it was the use of non-recurring funding, or the criticism thereof, which caused consternation elsewhere in Scotland. At the time, I remember receiving regular calls on behalf of more than one NHS senior manager clearly concerned lest the net would spread wider and more heads would roll.
The use of non-recurring funding to mask deficits has virtually faded now as an issue, but for years was a major point in Audit Scotland’s valuable annual overviews of the NHS in Scotland – and, believe me, it wasn’t confined to one health board area. Nonetheless, I don’t recall its being called “Labour’s selling off hospitals to pay the wages bill” scandal and I’m not sure it would have been fair if it had.
So will Labour’s current accusations stick? Can we legitimately blame Ms Sturgeon for what’s been going on in Lothian, certainly, and possibly elsewhere too? The answer is probably a bit of yes and a bit of no. Financial matters and accountability have rightly been tightened up massively since 2001, partially due to the Tayside troubles. Also, since the abolition of trusts (again under Labour), there is less mud-slinging between contractors and commissioners, basically because they are all part of the same bodies – NHS boards – now.
In the last dozen or so years, however, we’ve also seen nationally set targets for the health service proliferate and strengthen. Successive administrations have set successively tougher goals in a variety of areas from healthcare-associated infections to, erm, waiting times. The current target – that nobody with a waiting time guarantee should wait more than 18 weeks from referral to treatment – is particularly stretching; it essentially means that patients have to be seen and treated in a fraction of the time than just 10 years ago.
Lest we forget, former health minister Susan Deacon’s Our National Health, published in 2000, set a maximum waiting time of nine months for treatment by 2003 (down from 12 months previously), but that only kicked in once you’d had your first outpatient appointment; 18 weeks referral to treatment is a huge, huge improvement.
It’s also a huge undertaking, particularly when budgets are tight. Financial constraint may well be an incentive to do things differently, as Ms Sturgeon and others have said, but it can also prompt creative thinking of the type sadly seen at NHS Lothian. Presumably none of the staff wanted to make patients wait longer than necessary, but manipulating lists to meet targets became the Lothian way.
Arguably, then, by setting ever-tougher targets, at the same time as squeezing budgets, Ms Sturgeon has some responsibility for managers’ unfortunate inventiveness – but does that really mean that it’s the “SNP’s hidden waiting list”? Probably no more than the old Tayside troubles, or, indeed, previous waiting times problems (deferred list, anyone?) were “Labour’s NHS scandals”.
Let’s just pop back to 2002 for a moment and hear from John Swinney: “A culture has been created that forces hospitals to use every dodge in the book to get their waiting lists figures down and responsibility for this lies squarely at Labour’s door.” None of this would have come to light if the SNP had not ceaselessly pursued Labour over waiting lists,” added the then SNP leader.
Perhaps, then, Ms Baillie and Labour are only getting their own back with today’s inflammatory words. But wouldn’t it be grand if political parties, instead of name-calling and blaming, actually worked together to create a culture which puts patients first? Now that would be a pud worth having.