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By stewartb
When a public service in the UK is devolved and the same service has over a decade or more declined into crisis in England where it is the responsibility of the all powerful Westminster government – a crisis widely attributed to under-funding/under-investment in the face of rising demand – how on earth can dependent devolved governments with very limited fiscal levers in Belfast, Cardiff and Edinburgh do more than deliver at most a marginally better performing public service? The NHS is a key case in point.
The incoming Starmer government commissioned a review of the state of NHS England from Lord Darzi: it reported last September. Dr Kennedy’s BMA colleague, its chair of Council, issued a press statement on September 11 in response: ‘Lord Darzi’s NHS review a ‘deeply sobering’ assessment of a ‘severely’ broken NHS, says BMA’.
See: https://www.bma.org.uk/bma-media-centre/lord-darzis-nhs-review-a-deeply-sobering-assessment-of-a-severely-broken-nhs-says-bma
‘Responding to Lord Ara Darzi’s independent investigation of the NHS in England, Professor Philip Banfield, BMA council chair, said:
“The previous government gaslit doctors and refused to acknowledge the damage caused by years of underinvestment. The BMA has tirelessly spoken out about the challenges our health service faces, particularly regarding staff shortages, so one might expect that Lord Darzi’s review, which echoes many of the Association’s concerns, would be met with a sense of relief—finally, someone understands. While the findings are unsurprising, seeing this report so clearly call attention to just how broken our beloved NHS has become, with the devastating impact on our patients, is deeply sobering. (my emphasis)
“It’s no secret that the newly elected government inherited an NHS widely wrecked from year upon year of relative underinvestment – especially in general practice. ..” (The BMA fails to acknowledge Darzi’s further emphasis on shortfalls in capital investment.)
The BMA statement adds: “The country is getting sicker, with the most disadvantaged disproportionately affected; in parallel, we need investment in social care, public health and illness prevention to reverse the stark health inequalities outlined in the report..”
And: “…. an honest conversation with the public about what money goes where, what will and will not be provided, and what will be rationed until additional resources are made available, is imperative.”
Notwithstanding his catalogue of NHS England’s failings due a complex of reasons but substantially caused by Tory austerity – “The 2010s were the most austere decade since the NHS was
founded” – Darzi writes this of NHS England:
“Despite the challenges, the NHS’s vital signs remain strong. The NHS has extraordinary depth of clinical talent, and our clinicians are widely admired for their skill and the strength of their clinical reasoning. Our staff in roles at every level are bound by a deep and abiding belief in NHS values and there is a shared passion and determination to make the NHS better for our patients. They are the beating heart of the NHS. Despite the massive gap in capital investment, the NHS has more resources than ever before, even if there is an urgent need to boost productivity.”
The tone is rather different from the BMA’s Dr Kennedy with his NHS Scotland ‘is now dying before our eyes’! To paraphrase the BMA’s chair on the Darzi report: a senior representative of the BMA gaslights Scotland’s electorate and refuses to acknowledge the damage caused to the NHS in Scotland and across the whole of the UK by Westminster governments’ austerity and their underinvestment in NHS England.
But Darzi cautions: “It has taken more than a decade for the NHS to fall into disrepair so improving it will take time. Waiting times can and must improve quickly. But it will take years rather than months to get the health service back to peak performance. I have no doubt that significant progress will be possible, but it is unlikely that waiting lists can be cleared and other performance standards restored in one parliamentary term.” But all the while, NHS Scotland will have died?
Talking-up Scotland 'Albatraz' 
Made it to the shops today, the front pages of the daily rags, Scotland’s a basket case, a wasteland, the ‘SNP’ have ruined it for everyone best vote for English rule then.
No thanks!
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It’s not ‘broken’ in England’s NHS that’s being deliberately broken up…
I heard a programme many years ago on the BBC radio programme (when it was a bit less far right wing etc) and it was about the NHS, and Thatcher. She’d started the ball rolling to have the NHS sold off to the US, and the neocons were running with it after her ousting, however, it seems it was stalled for a short while but the momentum and infrastructure shall we say, has been in place for decades, to sell off the NHS lock stock and barrel, cheap at the price, masses of profit to be made, at great cost to those who will suffer and die because of not having insurance etc, as happens in the US.
Be prepared to have your house up for sale if you need treatment, people of England! If you are lucky that is. My parents would be horrified at this, given NHS was hard fought for by them and their parents.
No healthcare for the poorer folks, and people dying on the streets, is that Ok Scotland? NO thanks.
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As Scotland’s shoppers (and voters) view the front pages of newspapers without having to buy them whilst in supermarket queues and elsewhere (perhaps via the BBC), the messaging that NHS Scotland is ‘really bad’ and it’s that SNP’s fault, is fed drip by drip by drip – constantly, repeatedly – into the nation’s and the electorate’s consciousness.
After all, according to BMA Scotland in the press, NHS Scotland ‘is now dying before our eyes’.
Meanwhile in another universe, the BMA publishes this about NHS Wales and its relationship with Westminster government policies. Professor John Watkins, chair of the BMA Welsh public health medicine committee writes this on the BMA website (March 31, 2025): ‘Unprecedented demand: how the NHS has been brought to its knees – ‘Corridor care’ is endemic in all major emergency departments in Wales, resulting in patient harm and loss of life’.
See https://www.bma.org.uk/news-and-opinion/unprecedented-demand-how-the-nhs-has-been-brought-to-its-knees
The professor notes: ‘… in recent years, things have been different, something has changed, it is not the demand that becomes unprecedented but the ability of our broken NHS to cope, resulting in a healthcare system failing at all levels. (my emphasis)
‘The Labour government in Westminster, on election, recognised that, nationally, the NHS was broken, yet this should come as no surprise to anyone, it has been brought to its knees by a perfect storm caused by many years of underfunding, lack of strategic planning, lack of a realistic programme of training and recruitment of doctors and nurses and failure to adequately support social care, particularly for the elderly and infirm.’ The clear implication here is of a negative spillover to Wales of Westminster policies and actions. (And yet, NHS Scotland performs more often that not relatively well compared to its rUK peers.)
The Welsh BMA chair goes on: ‘The challenge for politicians in Westminster and Cardiff Bay, is what to do about it? While prevention of ill-health is a long-term strategy, the ageing population, with baked-in chronic disease, is a problem for the here and now. Lack of GPs and access to community services, results in over demand for ambulances, for non-urgent conditions, with patients often presenting at a late stage of illness.
‘Healthcare, social care and wider society are not separate entities that can be compartmentalised, each has its part to play. More funding is needed in our public sector services, in Wales. For example, we should not be closing schools of nursing at a time of national need, as has just been announced by Cardiff University and hoping that recruitment from overseas can fill the gap. As the general public, we need to act responsibly, not just on personal health but how we use services, thinking twice before calling ambulances, or attending emergency departments for self-limiting and chronic conditions.’
(According to the Nursing Times from April 10, 2025 – ‘A university that was considering scrapping its nursing school has found an “alternative proposal” that would see the school saved but the number of nurses it trains reduced’.)
More from the Welsh BMA chair: ‘As a society we need to stop deluding ourselves that we can get more services for less investment. The public sector has been cut to the bone, increased technology and innovation and new and improved but expensive drug therapy result in people living longer. This growth in the aged population means the NHS of the future is going to be more expensive than Nye Bevan ever conceived and will need change and investment to meet this challenge.’
Meanwhile, in the world that the leadership of the BMA in Scotland inhabits, NHS Scotland – (but not the NHS in England, Wales and/or NI?) – is ‘now dying before our eyes’. The BMA in Wales appears to acknowledge a link between the state of the NHS in Wales and a ‘public sector cut to the bone‘ by Westminster government policies. Lord Darzi’s stinging review of NHS England (September 2024) also pointed to the serious, negative impact on the NHS of prior Westminster government austerity. Notably, the BMA in England has referred to ‘an NHS widely wrecked from year upon year of relative underinvestment‘.
Perhaps the BMA leadership in Scotland – unlike its peer in Wales – is confused and thinks that Scotland is already functioning as an independent country with the full financial and economic powers of a normal nation-state! Or perhaps certain individuals who are able to acquire high media profiles in Scotland can’t quite square a claim of being ‘better together’ with being both ‘together’ and dependent upon a system of government in Westminster which for over a decade has ‘widely wrecked’ (in the words of a leading BMA Wales figure) the NHS in the UK.
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