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Scotland is sick

Scotland spends more per capita on the NHS than England does, but by next year it will have Europe’s lowest life expectancy, says Fraser Nelson

15 November 2003

12:00 AM

15 November 2003

12:00 AM

Scotland spends more per capita on the NHS than England does, but by next year it will have Europe’s lowest life expectancy, says Fraser Nelson

Imagine a British National Health Service flowing with French or German levels of funding. This dream, we are promised, will soon be delivered in return for higher taxes. But for the impatient, there is a solution: visit Scotland.

For some time now, NHS Scotland has been living in Tony Blair’s promised land, enjoying European levels of health spending. Its NHS budget of £1,300 per head is a full 21 per cent higher than England’s. But instead of being an alluring example of what lies ahead, Scotland warns of disaster. Next year, it will claim two records: for Europe’s highest state health-spending and its lowest life expectancy. It is living proof that the NHS system does not work.

Gordon Brown’s motherland was strangely absent from the list of countries sized up by the Treasury when it examined health systems from around the world last year — a study which predictably concluded that money, not organisation, was the problem. Yet only Scotland shows what happens when cash is stuffed into an unreformed state-run monopoly stamped with the DNA of the late 1940s. It is the only country in the free world to have tried what Brown is now aiming for.

The extra cash is not thanks to any act of magnanimity. In Scotland the NHS has long been richer than in England, thanks to the archaic system used by the Treasury to divide up public spending: it sends a fixed chunk to Scotland whether it needs the money or not. The result is a generous spending advantage, guaranteed by London politicians, who have for decades shovelled money at the Celtic Fringe whenever they feared for the Union.

As if by way of apology for the poll tax, Scotland now has been sent its NHS funding early. So next year government health spending in Scotland will work out at 8.7 per cent of its entire economy — the highest ratio in the developed world, according to the OECD, never mind Europe. Of all Scotland’s health problems, state spending is not one.

NHS Scotland has achieved several benchmarks of which Blair would approve. For every 100,000 people, Scotland has 75 doctors, against England’s 55. There is almost twice the proportion of hospital beds and the average Scottish GP has a more manageable list size of 1,400, against England’s 1,840.


But all this was true in 1997, even after the years of Conservative parsimony. The chilling warning for Mr Blair, and for the British taxpayer, lies in what happened when the cash started to flow. According to Labour’s tax-raising orthodoxy, cash buys results: more money in the NHS means better performance. This was certainly the logic used to sell National Insurance rises to a suspicious British public last year.

According to this theory, NHS Scotland — which gave outpatients an average 41-day wait in 1997 — would start to improve roughly in proportion to the extra amount of cash being injected into the system. Plot the money and results on a graph and there is indeed a link, but, as if in a statistical horror story, it goes the wrong way. There is now 50 per cent more money in NHS Scotland, but waiting times have soared to 56 days — an entire fortnight longer.

This is no freak result. Scotland’s waiting times have been creeping up steadily, as if chasing the extra money being force-fed into the system. Treating waiting lists with extra cash has been like treating fire with petrol.

Other indicators are similarly depressing. The wait for the walking wounded in a Scottish accident and emergency ward doubled to 40 hours between 1998–99 and 2000–01. So where, Scots might ask, is all the money going?

The answer can be found in the hospital accounts. Between these three years, for example, a mysterious bout of inflation has gripped Scotland’s health sector, pushing up the average cost of accident and emergency cases by 30 per cent and theatre surgery by 39 per cent.

The cost surges in some hospitals would not look out of place in Weimar Germany. The price per medical case at Aberdeen Royal Infirmary and Glasgow Victoria Infirmary more than doubled over this period — not all of it, it is safe to say, through advanced medical techniques. Little wonder that Scotland’s health-spending bonanza had no effect. It found itself chasing hyperinflation and being unable to keep up with an NHS system which was simply growing fatter and fatter.

At every criticism of their health policy, Labour MSPs in the Scottish Parliament point to this extra money, as if this was an end in itself. Labour, they say, has brought more doctors, nurses and investment. This is indeed true — but the staggering truth is that NHS Scotland has not improved as a result. In spite of all this money, twice as many patients leave Scottish hospitals intending to make a complaint than patients in lower-funded England.

Mercifully for Jack McConnell, Scotland’s First Minister, the full extent of Scotland’s spending advantage remains a well-kept secret. His civil servants have expressed the need not to boast about the extra cash within earshot of envious English MPs. So when Scots watch television news from London, they readily identify with stories about the rundown NHS. Individual shock stories resonate on both sides of the border because, in spite of the substantial spending levels, there is no perception of quality difference. Indeed the Daily Record, Scotland’s best-selling tabloid, held a poll where 85 per cent of its readers suggested raising tax to pay for the NHS — apparently unaware of the terrible truth: Scotland already has the extra money and the NHS still doesn’t work.

The situation is not likely to improve. The Scottish Executive used its devolved powers not for radical reform, but for tasks like nationalising a hospital in Glasgow and rejecting Mr Blair’s Foundation Hospital proposals. Scandalous health statistics — children born in Glasgow have an average life expectancy equal to that of Bulgaria — are shrugged off by MSPs as a regrettable fact of life, in the same bracket of inevitability as the poor weather.

The NHS lesson may be lost on Scotland but it is valuable to England: it shows that the NHS as it stands is a rare structure, capable of swallowing billions with nothing to show for it, short-changing both the sick and the taxpayer. Mr Blair will win his battle with the Lords over Foundation Hospitals, but this watered-down legislation will mean tinkering with about 5 per cent of the NHS — certainly delivering no changes in time for the general election that is expected in 17 months’ time.

England, also, was never as poor as the Chancellor had it believe. Last March, the Office for National Statistics admitted to ‘finding’ extra health spending which amounts to some £5.4 billion this year alone. The promise to lift UK health spending to European averages by 2005, made by Mr Blair on the sofa of Breakfast with Frost, was a con all along. Britain was going to hit this target by 2003 anyway, without a penny of Mr Brown’s extra tax.

So England does not have to imagine an NHS with European average levels of funding. It has this already — and is now heading for the same system that has failed Scotland so spectacularly.

Fraser Nelson is political editor of the Scotsman and the Business.


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