AS we approach the General Election, the NHS is front and centre as the issue that matters most to the people of Scotland.
And while the decline in the NHS in Scotland has been nowhere near as steep as it has been in England, it has nonetheless been catastrophic for the millions who depend on it.
Having worked as a doctor in both NHS Scotland and NHS England, I can tell you I would much rather be a patient in Scotland. We have maintained more capacity and lower waiting lists. We have managed to retain more UK trained staff. Crucially, we have managed to resist privatisation. We have our problems, and it is not how it once was, but the NHS in Scotland is still recognisable to me.
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Given the level of control Westminster has over NHS Scotland, and the drive of the Tory Government to replace much of the NHS with the private healthcare sector, resisting the privatisation of NHS Scotland has been no mean feat. It has required effort. It has also required raising taxes. To my mind, the extra effort taken and the additional money spent has been well worth it; most of my patients would, I’m sure, agree.
We now must look to the future. How do we protect the NHS going forward and how do we recover it from 14 years of austerity and four years of Covid backlogs?
To date, around 0.2% of the NHS budget in Scotland has been redirected to the private sector. In England, it is about 7%. At the last measure, there were 143 physician associates in Scotland versus 3215 in England. We are, in Scotland, clinging on to the true values of the NHS as best we can.
The health service continues to struggle. Despite these efforts, the same trajectory seen elsewhere in the UK is also seen in Scotland. The health system is creaking at the seams. There isn’t enough capacity to manage the health needs of Scotland. Given our NHS budget is tied to the decisions of those in Westminster, we can only hope that the next UK government will invest more than the last.
As we curb the burning sense that Scotland could do better, we must face the upcoming election and choose between a Scotland led by Labour, or a Scotland led by the SNP. Both manifestos offer something to the NHS in Scotland. But it is what is missing from the election promises that matter most in regard to recovering Scotland’s health service.
There is no promise by Scottish Labour to protect free prescriptions, or free hospital parking. No reassurance that the NHS will be protected from further austerity. There has certainly not been anywhere near the economic commitment needed to start recovering the health service. Critically, there is no promise to protect Scotland from the same private sector takeover as we are witnessing south of the Border.
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Such reassurances would be popular with the voting public and would seem easy to make. Yet no such reassurances are forthcoming. All we have heard so far is an assurance from the UK Labour Party that they will increase the use of the private sector:
“Recognising the urgent need to bring down waiting lists, Labour will use spare capacity in the independent sector to ensure patients are diagnosed and treated more quickly.” - Labour manifesto, 2024
It makes me nervous. What seems like a straight-forward reassurance to not use private healthcare to replace NHS services is not forthcoming. Equally, the failure to move more decisively away from the austerity program of the last failed UK government is also concerning. Overall, I have little confidence that a Labour-led Scotland would either protect or recover the NHS in Scotland adequately.
The SNP could do a better job with the NHS. In particular the SNP could put more effort into ensuring the management of the NHS is more clearly focused on patient outcomes. But going by the evidence of my eyes and ears, the SNP has managed for what has been a gruelling 14 years to keep the NHS above water and has crucially kept the NHS ethos alive. Should the election results fall in favour of the NHS, then I have little doubt we could go some way to recovering the NHS in Scotland over the next parliament.
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