Politicians know that healthcare is a top political priority in Scotland. In BBC Scotland’s recent poll a “guarantee that NHS spending would be increased so that it at least keeps pace with health spending in England” drew the most favourable response of any other issue. Just before the purdah period there was a constant stream of pre-election announcements by the Scottish Government, most significantly on the redesign of the health service. Yet the changes to the health service are far from over. It will remain a key focus for the parties throughout the election period and into the next Parliament.
On 1 April the integrated authorities for health and social care came into being, sparking one of the most fundamental reforms of the NHS in Scotland. It was change largely without criticism, but a long-term project still in its early days. Nevertheless, opposition parties have been keen to point out issues of difference, such as funding for mental health and protecting local services. In truth, there is not much to distinguish between the parties.
Targets and cutbacks are the hot topics when discussing delivery. Whilst the SNP have sought to defend A&E waiting times and improve patient flow, Kezia Dugdale was out on the streets of Paisley this week to promote Labour’s commitment to protect local health services and prioritise primary care. The party was criticised for a quickly unpicked pledge for GP appointments within 48 hours, but have been active in complaining about reduced services in hospitals, particularly in the West of Scotland. Meanwhile, the Scottish Conservatives have promised to put patients in charge, with reduced waiting times and reducing bureaucracy. The Scottish Lib Dems want to see more power devolved back down to frontline staff, freeing them from central targets.
Funding the NHS
Funding is a critical issue for all of the parties, tripping over themselves to say how much money they intend to spend. The SNP have pledged to raise the NHS budget in real terms. The Scottish Conservative Party are committed to maintaining health funding and protecting NHS funding with a health guarantee. Scottish Labour promised that through their proposed tax increase they would increase health funding. The Scottish Green Party pledged to not only keep the NHS in public hands, but also to review all aspects of private sector delivery. Overall funding for the NHS would be increased.
All of the political parties are focusing on mental health – long seen as underfunded. The SNP have championed the introduction of mental health waiting times, a dedicated Ministerial brief and £150m fund to improve services over the next five years. The Scottish Lib Dem leader braved another media event featuring animals to demonstrate the Party’s commitment to deliver a step change in mental health, promising every GP practice will be able to have an additional qualified mental health professional to support and treat patients. Meanwhile, the Scottish Conservative Party have committed to a ten year mental health strategy, with an additional £300m invested over the next Parliament. Green MSPs claim they will fight for investment for a better understanding of the causes of mental health problems within mental health services.
Perhaps the most radical approaches are yet to come. The SNP are known to be considering rationalising the number of NHS Boards in Scotland having already announced a radical reshaping of the NHS through trials of new GP clusters, new elective treatment centres and integrated health and social care. The Scottish Conservatives meanwhile want to put pharmacies at the heart of the system through the expansion of the Minor Ailment Service, along with a network of Recovery Centres. The Scottish Green Party are perhaps more radical still, believing that it is vital to look at patient’s economic and emotional needs as well as clinical health issues, developing comprehensive care plans for patients.
The NHS is facing constant reform. No single reform will transform patient’s experiences. All of the parties are trying to grasp an idea that will help change the way the NHS operates for the better, but it is very unlikely that any party has the silver bullet. The NHS is simply too complex and the issues and challenges it faces too large and diverse to change within a decade, let alone a Parliament, but there can be little doubt that major change is on the way.