Another Scottish budget and another dire warning from the spending watchdog, Audit Scotland, that the National Health Service in Scotland is out of control and heading for disaster. With almost one sixth of the Scottish population on a waiting list, around 10 per cent of beds occupied by people who shouldn’t be there, and daily horror stories from accident and emergency, the service is long past breaking point. Yet the NHS is gobbling up 40 per cent of the entire Scottish budget, according to Audit Scotland’s director, Stephen Boyle. With increased staffing and higher pay, the health service is simply ‘unsustainable’.
The NHS, free at the point of need, is no longer sustainable
We have known this for years. Audit Scotland’s last shock report was only eight months ago. In 2022, the BMA admitted that in large parts of Scotland, the health service is simply not functioning. Last week, Aberdeen Royal Infirmary started turning patients away. This is in one of the wealthiest constituencies in Europe, the heart of the North Sea oil and gas industry.
The usual stage army of supposed experts were dragged onto Good Morning Scotland to answer the inevitable patsy questions from presenters who seem to be on autopilot. Clinicians, trade unionists, academics, and politicians all wring their hands and bemoan the state of the NHS. Ageing population, bed blocking, efficiency, pandemic, prevention, AI, IT, CTA – all the usual explanations were wheeled out.
What none of them seem prepared to admit, except perhaps the BMA, is that the NHS, free at the point of need, is no longer sustainable. Audit Scotland states that if nothing changes, spending will rise to 50 per cent of the Scottish budget over the next 50 years. The vast majority of the NHS budget goes on staffing, which has risen by 18 per cent since 2019 with no improvement in productivity.
The P-word – privatisation – is, of course, off-limits, even though the BMA’s Iain Kennedy said last year that an ‘all-you-can-eat buffet’ NHS is no longer possible. But no one is prepared to spell out what that means. This might include charging for certain services, like GP appointments, ending free prescriptions for drugs, using the private sector to speed up elective surgery, or outsourcing cosmetic treatments like gender reassignment surgery.
The Scottish government insists that staff are better paid in Scotland, which has led to fewer damaging strikes than south of the Border. That is true. But while this may appeal to the SNP’s public sector unions, it spectacularly misses the point. More and more NHS staff are treating fewer and fewer patients.
The National Care Service, announced three years ago as the greatest innovation in the NHS since its creation, was supposed to solve the problem of delayed discharge. At any one time, up to 10 per cent of beds are occupied by people who are well enough to go home but lack social support. The NCS legislation has now all but collapsed after the cost rose inexorably from around £500 million to £2 billion, with local authorities and unions boycotting it.
I’m almost beginning to feel sorry for the Scottish government because its critics have no answers either and simply parrot the slogans ‘free at the point of need’ and ‘aren’t our doctors and nurses wonderful?’ Many are. But the administration of the NHS in Scotland is clearly dysfunctional.
Short of getting Elon Musk to pile in and fire half the staff, there seems little prospect of this bureaucratic behemoth doing anything but continuing to wreck the health of Scots while consuming resources desperately needed for prisons, education, roads, green initiatives, and the rest.
Tens of thousands of people who pay their taxes are waiting years in agony for routine operations. Or rather they aren’t, because the inconvenient truth ignored by all the right-thinking folk is that the NHS is already being privatised by stealth. The number of Scots paying to have their hips and knees done has increased by 80 per cent since 2019.
This is already a two-tier service where those with money to spare can jump the queue rather than waiting two years for an operation.
This is shameful. The Scottish political classes know perfectly well what is happening. They’ve seen it already in the dental service, which now routinely turns away NHS patients in favour of those who will pay.
That is the state we are in, and none of the Scottish political class is prepared to admit it. They would rather preside over a fantasy NHS, where everything is basically working fine, than face the reality that throwing ever more public money into this broken service is good money after bad.
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