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On the face of it, these extreme waits referenced by the British Labour Party deputy leader in Scotland are wholly unacceptable. Why did they occur? Unless we know why, we can’t determine whether they are indicative of a whole system failure; local failure or indeed local incompetence; or due to particular clinical situations. We are very far from knowing where responsibility lies – local clinical management, health board management/oversight, Scottish Government officials, Minsters?

The British Labour Party in Scotland gets away with its ‘NHS “won’t survive” another SNP term’ nonsense only because the mainstream media in Scotland is unwilling to challenge it, unwilling to provide context and perspective, and the shunning of comparative accounts of NHS performance in Scotland, England, NI and Wales – unless unfavourable to the former. What NHS England gets (or doesn’t get) in terms of resources has a direct impact on the budgets available to governments in Belfast, Cardiff and Edinburgh.

So for context, from the Darzi report on the state of NHS England commissioned by the incoming Labour government and published in September 2024. Recall that NHS England is the ONLY health service in the UK funded by a government with ALL powers, ALL agency, necessary to set its level of resources to meet the needs and wants of England’s public and England’s heath and social care professionals.

From Darzi, Para 15: ’’Austerity. The 2010s were the most austere decade since the NHS was founded, with spending growing at around 1 per cent in real terms.’ (my emphasis)

Para 16: Capital. The NHS has been starved of capital and the capital budget was repeatedly raided to plug holes in day-to-day spending. The result has been crumbling buildings that hit productivity ..’ And: ‘The backlog maintenance bill now stands at more than £11.6 billion and a lack of capital means that there are too many outdated scanners, too little automation, and parts of the NHS are yet to enter the digital era.’ And: ‘Some £4.3 billion was raided from capital budgets between 2014-15 and 2018-19 to cover in-year deficits that were themselves caused by unrealistically low spending settlements.’

Para 17: ‘On top of that, there is a shortfall of £37 billion of capital investment. These missing billions are what would have been invested if the NHS had matched peer countries’ levels of capital investment in the 2010s. That sum could have prevented the backlog maintenance, modernised technology and equipment, and paid for the 40 new hospitals that were promised but which have yet to materialise. It could have rebuilt or refurbished every GP practice in the country.’

Para 18: ‘The pandemic. The impact of the pandemic and its aftermath: a bigger backlog than other health systems The combination of austerity and capital starvation helped define the NHS’s response to the pandemic. It is impossible to understand the current state of the NHS without understanding what happened during it.

‘The decade of austerity preceding Covid-19, along with the prolonged capital drought, saw the NHS enter the pandemic with higher bed occupancy rates and fewer doctors, nurses, beds and capital assets than most other high-income health systems. The NHS’s resilience was at a low ebb. What is less widely known, is that the NHS delayed, cancelled or postponed far more routine care during the pandemic than any comparable health system.’

(https://assets.publishing.service.gov.uk/media/66f42ae630536cb92748271f/Lord-Darzi-Independent-Investigation-of-the-National-Health-Service-in-England-Updated-25-September.pdf )

In marked contrast to the view of the British Labour Party’s deputy leader in Scotland – awith the nonsense that ‘the NHS “won’t survive” another SNP term’ – Lord Darzi concludes, despite his damning assessment (Para 26):

’Nothing that I have found draws into question the principles of a health service that is taxpayer funded, free at the point of use, and based on need not ability to pay’. And from Para 27: ‘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. Just as we in the NHS have turned around performance before, we can do so again.’

Now if NHS Scotland was performing worse than NHS England, the British Labour Party in Scotland’s condemnation of the SNP in government might be justified. Of course, Scotland is performing on many if not most metrics, better.

If NHS Scotland was performing worse than NHS Wales, the British Labour Party in Scotland’s condemnation of the SNP in government might be justified, as might be its claim that Labour in government in Scotland is what NHS Scotland needs to solve its performance deficiencies.

Of course, Labour in government in Cardiff presides over an NHS which performs worse than NHS Scotland on most metrics. Labour governing with devolved powers has not been able to counter the decade and more of Tory austerity and capital ‘starvation’ plus the impacts of the pandemic, as recognised by Darzi. How could Wales with a Labour government in Cardiff expect to be other than best marginally better than an under-resourced NHS England with only devolved powers? In fact, it is not even marginally better!