Visitors to this site will be familiar with the endless criticisms of the Cabinet Secretary for Health in the Scottish Government over the performance of NHS Scotland. These come from the corporate media and BBC Scotland, and from opposition politicians in Holyrood. I accept their right to criticise but for as long as Scotland remains within the UK – and supposedly ‘better together’ for it – I will argue that providing context, perspective and comparative assessments with England is legitimate and necessary.
Amongst the critics, prominent is the Tory health spokesperson and part-time medic, Sandesh Gulhane MSP. Perhaps a new report from the National Audit Office (NAO) on the state of the publicly-funded health service in England will interest him. It might be pointing him towards a ‘big breakthrough opportunity’ for his political career.
Given the bleak findings, perhaps his Tory colleagues in government in Westminster will finally get round to taking advantage of the silver bullet solutions he seems to imply are available to cure the ills of NHS Scotland IF ONLY the Scottish Government would listen to his words of wisdom!
Source: National Audit Office (17 Nov 2022) Managing NHS backlogs and waiting times in England.
Here are some key extracts: ‘At the start of the COVID-19 pandemic, the NHS in England had NOT MET ITS ELECTIVE WAITING TIME PERFORMANCE STANDARD FOR FOUR YEARS, NOR ITS FULL SET OF EIGHT OPERATIONAL STANDARDS FOR CANCER SERVICES FOR SIX YEARS.’ (my emphasis)
‘In February 2022, NHS England (NHSE) published a plan to recover elective and cancer care over the three years up to March 2025. IT HAS RECEIVED FUNDING FOR THIS RECOVERY, which is taking place at a time when the NHS is MANAGING OTHER MAJOR PRESSURES, including ONGOING EFFECTS OF THE COVID-19 PANDEMIC, ACCESS TO PRIMARY CARE, THE PERFORMANCE OF URGENT AND EMERGENCY CARE, WORKFORCE GAPS, AND PROBLEMS WITH THE SUPPLY OF ADULT SOCIAL CARE.’
However: ‘.. activity so far in 2022 has CONTINUED TO LAG BEHIND THE PRE-PANDEMIC LEVEL and is WELL BELOW THE PLANNED TRAJECTORY. To a significant degree, this is DUE TO AN OPERATING CONTEXT THAT IS MORE DIFFICULT THAN NHSE ALLOWED FOR in its plans.’
‘The NHS’s funding package is being eroded by inflation, so that its OVERALL FUNDING UP TO 2024-25 IS SET TO GROW MORE SLOWLY THAN THE LONG-TERM AVERAGE IN REAL TERMS. Given progress to date, we are concerned that the 129% activity target and the target to eliminate all waits of longer than 52 weeks by 2025 are AT SERIOUS RISK OF NOT BEING ACHIEVED. There are significant threats to the recovery, including the effects of strain on the workforce, UNCERTAINTIES about whether new initiatives will be able to deliver results as quickly as NHSE needs them to, and the pressures elsewhere in the NHS and adult social care.’
The NAO also states: ‘NHSE’s elective recovery programme partly relies on initiatives which have potential but for which THERE IS SO FAR LIMITED EVIDENCE OF EFFECTIVENESS’
‘Between the start of April and August 2022, the NHS was on track to achieve its target to INCREASE THE USE OF INDEPENDENT PROVIDERS for elective care, including diagnostics and day-case activity, to REACH MORE THAN 120% OF THE LEVEL SEEN IN THE EQUIVALENT PERIOD IN 2019-20.’
‘NHSE has estimated that, in 2021, THE NHS WAS AROUND 16% LESS PRODUCTIVE THAN BEFORE THE PANDEMIC. Some of this RESULTS DIRECTLY FROM THE PANDEMIC, for example INCREASED SICKNESS ABSENCE AND INFECTION PREVENTION AND CONTROL MEASURES. An internal NHSE review has identified a range of other causes, including REDUCED WILLINGNESS TO WORK PAID OR UNPAID OVERTIME AND REDUCED MANAGEMENT FOCUS ON COST CONTROL AND OPERATIONAL RIGOUR AS the NHS sought to maximise activity.’
(As an aside, on the NAO conclusion that ‘RESULTS DIRECTLY FROM THE PANDEMIC’, recall this from Alex Cole-Hamilton a short time ago: ‘How dare Humza Yousaf blame covid for an A&E crisis …’!)
If all this had been in an Audit Scotland report on NHS Scotland, imagine the headlines that BBC Scotland’s journalists could have written: imagine the quotes that Dr Gulhane and his ally in talking down NHS Scotland, Ms Baillie could have provided!
Interestingly, the NAO notes: ‘DHSC (Department of Health and Social Care) has an essential part to play too in holding the NHS to account, providing support and challenge as needed.’
So is the DHSC – i.e. the ‘government’ – NOT the prime responsible body for NHS performance in England but rather the NHS trusts?