What is the state of health in Scotland?
This article was originally posted on 22nd March, 2023 for Lexington Communications.
Like its English counterpart, the waiting lists resulting from COVID and discontent among frontline workers provide ample challenges for NHS Scotland. While historically there has been greater funding per capita for healthcare in Scotland than in England (although this gap had diminished to 3% as of 2021), a recent report by Audit Scotland has laid bare the issues facing the future SNP leader. The report paints a picture of ‘extreme’ and ‘severe’ pressures, worsening performance on cancer targets, and ‘financial struggles’ against the backdrop of slow progress in recovery from COVID. Scotland’s health boards (the equivalent of ICSs in England) are said to be expected to deliver services significantly beyond their budget's capacity, with only 3 out of 14 territorial health boards on course to break even this financial year.
A lack of coordination and communication with the NHS by Government is to blame for this, according to Audit Scotland, with political choices driving decisions. Its proposed solutions to these issues could make useful reading for Hamza Yousaf, Ash Regan, and Kate Forbes. Such a verdict is especially strange, as there is no divide between NHS Scotland and the Scottish Government as there is between DHSC and NHS England, although individual NHS health boards do operate with a degree of autonomy. While some action is being taken - such as the publication of the Scottish Government’s first-ever data strategy for health and social care, there is clearly work to do for the next first minister.
The problems go beyond health care. In social care, there are issues of a “postcode lottery” in both charges and availability, and calls for more consistency alongside improved pay and conditions for workers. The number of whole time equivalent GPs is down by 26% since 2017. A recent survey of dentists in Scotland suggest the NHS haemorrhaging members of the profession to private practice. While some action is being taken in the healthcare space, such as the publication of the Scottish Government’s first-ever data strategy for health and social care, there is clearly work to do for the next first minister.
Healthcare: What are the candidates saying?
The candidates for the SNP leadership have offered different visions for how to improve healthcare in Scotland.
Humza Yousaf
As the current health secretary, Yousaf has had his record attacked by his opponents who point to the failures of the system discussed above; his supporters, however, say the lack of strike action by health workers in Scotland and the country’s handling of COVID highlight his strengths, at least compared to their southern neighbours. He recently said in a debate that the entire Government is “focused on reducing those waiting lists". He also said that those who can earn the most should pay the most for healthcare.
A significant dividing line between candidates is the potential creation of a National Care Service (NCS). This was proposed by Nicola Sturgeon to help improve adult social care in Scotland, but faced resistance as some feel that the shift to accountability at the national level may not improve the quality of care. Mr Yousaf said working with critics of the scheme in to find compromise could offer a path forward.
Kate Forbes
One of those critics is his opponent, Kate Forbes. She wants to rethink the National Care Service plans because she believes the scheme does not have the buy-in and backing of providers which it will need. She has also proposed setting up an inquiry to look at giving the NHS a radical overhaul; this reform, however, would retain the underlying principle of free at the point of service.
Ash Regan
Ash Regan has said that improving the health service would be her main objective, but has suggested pausing the NCS plans. She believes ‘there has been too much focus on targets and goals’ in healthcare as opposed to healthcare worker welfare, a fairly standard populist complaint by those without first-hand knowledge of the inner workings of the NHS. On other issues, though, the candidates are more aligned.
In a debate on the 14th March, all candidates emphasised their focus on adequate pay for NHS staff in response to an audience question about healthcare. Regan in particular stated a desire to have a summit where frontline workers inform her of their needs. However, both Yousef and Forbes have been directly involved with negotiations on this issue in their current roles and have suggested there are limitations to the pay offers they can provide.
Life science: What are the candidates saying?
The Scottish Government have consistently advocated for the life sciences sector; the extensive reforms of the Montgomery Review alongside the preceding reforms of medicines availability both demonstrated a commitment to patient centric reforms that are still friendly to industry. However, their actions have sometimes not met the rhetoric of their support, with NHS Scotland not actively encouraged by the Government to adopt innovative practices.
However, the SNP need a strong life sciences industry to bolster their case for a second independence referendum. The argument for independence is only feasible if Scotland is economically viable, which is only possible through the growth of a handful of sectors. The SNP needs to have a compelling prospectus to sell to reluctant “Yes” voters. Life sciences is defined as a priority sector of economic significance by the Scottish Government, as employment in the sector has steadily increased to 40,000 people and the turnover generated by companies has continued to grow. Those operating in key sectors where Scotland have a comparative advantage – financial services, energy, food & drink, tourism and crucially life sciences – will have an opportunity to make a strong case to the new First Minister, whoever they may be.
Humza Yousaf
Despite the possibilities available in this sector, life sciences itself has rarely been discussed by the candidates so far. Humza is acutely aware of the need to ‘fix the NHS’; yet he is the man currently at the wheel. Therefore, we can assume little will change on his direct approach. This extends to the life science sector, where he has proven to be happy to engage - to a point, positioned as neither hostile nor effusive.
Kate Forbes
As the current Finance Secretary, Forbes will understand the financial blackhole that is NHS Scotland and that increasing funding cannot solve the demographic pressures in the long term. Her right-of-centre leanings suggest greater private sector involvement in reforming the NHS could be sought by a Forbes administration. Her pro-business views certainly mean she is more likely to share the industry view that innovating in processes, structures, approaches – and of course interventions – is one of the most important ways to NHS Scotland can be sustainable in the long term.
Ash Regan
As with many of her policies, Regan has given scarce details about her plans for cooperation with the life science industry. Her relative inexperience makes her something of a dark horse; there is no great track record of engagement that offer insight into her likely attitude to the industry. The only hint of an appreciation for the sector is the presence of Edinburgh BioQuarter – the emerging life sciences cluster based around the Royal Infirmary – in her Edinburgh East constituency.
What does this all mean for the future of healthcare in Scotland?
While healthcare has been an area under scrutiny for the candidates, the role of industry is yet to be made apparent by any particular candidate. However, the answer to that question could define their premiership, given the importance and need for healthcare reform. Will the new First Minister embrace the power of technology and innovation as a way to help make NHS Scotland sustainable? Given the lack of commitment so far from the candidates, it is incumbent on all those involved in the Scottish – and indeed British - life sciences sector to make the case to the new administration. In making a case for precision medicine, genomic medicine, AI, diagnostics and screening, quicker use of the best treatments and devices, and a range of other innovations, the future of healthcare in Scotland, and the future of the country itself, can be shaped.
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