Brexit-inspired crisis may demand a break from ‘normal’ politics

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Commentary: Derek Bateman

The time is coming when normal politics may have to be put on hold in the national interest. Yes, just like wartime. The implications of a bad Brexit will transcend partisan considerations. The people will look into the abyss and demur. Save us, they will demand.

At least the sensible ones will. We currently have a large schadenfreude minority apparently prepared for the country to really suffer to justify their own position and others so lost in parochialism they will take the plunge hoping someone will appear from nowhere with a soft mattress to land on.

Derek Bateman

The logic of the Brexit orbit is to pull us irresistibly to the EU centre. Every cause and effect points to retaining the current position. What’s to be done about the medicines agency and the banking authority based in London, for example? They will depart taking with them highly paid jobs and 40,000 hotel nights a year. But still the UK will need to replace them and replicate their work and meet the EU’s standards anyway. Logic? Stay in the EU and keep them and their jobs and economic spin off here.

The tragedy for the UK is that both major parties at Westminster, for differing ideological reasons, are on the same side – isolationism. Those in both Tory and Labour parties who can see the unfolding disaster will have to put country first and join with the pro-Europeans in Liberals, SNP, Greens and Plaid to mount a UK-wide save-the-country campaign. It could lead to a new politics. *

HEALTH

But there is another area where big tent politics is becoming critical in order to save us from catastrophe – the state of the NHS. To many, the health service is in its way as important as EU membership, perhaps more so. It represents something about Britain, its past and future, which binds us together beyond borders, albeit managed territorially. It is one of those areas of life that gives us quiet satisfaction, pride even. It makes us not only feel well but feel good, like a full stomach or money in the bank. I think that’s why in public debate it is treated like a new-born baby, precious yet vulnerable.

But just as warm words are soothing when ill, they won’t replace a blood transfusion or perform a hip replacement. Talking up the NHS, despite its many shortcomings, is applying ointment to a broken arm. More fundamental surgery is required.

The evidence mounts that this most essential of services is in serious trouble; that the management knows it, that the politicians are transfixed. Like Brexit, the first requirement is honesty. From health professionals to civil servants to ministers and MSPs, there has to be a clear-sighted view and an admission that the present funding of the NHS cannot go on, if we wish it to survive.

Throughout the devolution years the warning lights have been flashing on every front – the rising cost of medicines, the increase in prescriptions, an ageing demographic, an unfit population, new systems and equipment at exorbitant cost, fewer students entering medical degrees, pay not keeping pace, the growth in contract nursing and the rise in administration and management – 18 per cent of the workforce total last year, easily second to the number of nurses (43%).

The flashing lights are now accompanied by a klaxon. Holes are appearing in care. Services are being withdrawn, both in hospital and GP form.

The recent case in the south-west is part of a trend. The BBC reported that NHS Dumfries and Galloway was forced to suspend admissions for a week and downgrade the casualty unit to a minor injuries facility because of a shortage of doctors.They said the hospital was open and fully staffed but that a challenge remained in securing medical cover on an on-going basis.

RECRUITMENT

A doctor from elsewhere in Scotland contacted me this week. Even in our highly regarded and respected practice we have been unable to recruit to a 5-session (two and a half days) GP post. We already have 3 practice nurses, 2 health care assistants and an advanced nurse practitioner. We are now going to advertise for an unscheduled care practitioner and I hope we might get one. But even if we do that, if another GP partner leaves the practice soon, we are unlikely to recruit and, as a result, we could go under.

Recruitment, instead of access to a prized profession, is stalling. As are genuine attempts to streamline and improve provision by the merger of health and social work organisations.

But why is this happening? I’m afraid it’s the same problem as Brexit – the politicians are afraid to confront the reality because to them the costs are too high, both literally and politically. Finding the money means changing priorities which in turn means disappointing others and fire-fighting. Altering how things are done and removing facilities to centre them more sensibly, causes heated reactions in communities where there is already evidence of under investment. No politician wants to face the wrath of the voters and no amount of cold logic will convince an inflamed crowd.

So cowardice is part of the story but so is irresponsible scaremongering.

Here’s my doctor again: All of them – Tories, Labour, LibDems, Greens, SNP – are in denial about it. Instead of coming together to forge a way through the crisis they continue to use it as a political football. At the same time the Scottish Government is in paralysis and reluctant to change because of the appalling behaviour of the Scottish media.

HYPERBOLE

The hysterical and deliberate misreporting by journalists of issues in the NHS doesn’t just terrify those about to use hospital services. It forces professionals on to the defensive. Opposition politicians, while justified in pointing out deficiencies, play to the media with hyperbole. This was the point made by the Nuffield Trust which found much pioneering work in Scotland that could be replicated elsewhere in the UK but, crucially, deduced that: The Scottish NHS faces a serious financial predicament. The need for savings is at least as great as for other UK countries, and health boards are struggling to find ways to deliver them. Limited national planning for the next few years and a polarised, hostile political context make an honest national debate difficult. While the strengths of the Scottish NHS could help it to save money, there is also a risk that they are undermined by the intense financial squeeze. It adds: Several interviewees from across the spectrum of roles referred to a polarised political culture, with the SNP Government seeking majority support for independence and a largely hostile press looking to attack their record on the NHS.

This is the result of an infantilised political culture where mouthy politicos seek not to uncover truth and find remedy but to stoke resentment via a trivialising media. The result is a failure of nerve, a lack of honesty and operational stasis. Pursuing independence does not mean sidelining essential services.

An offer to help the SNP out of its difficulty, a government acceptance that the opposition might have something positive to contribute and a limited truce on horror attacks would release everyone from their silo and bring a much needed improvement to the quality of politics and ultimately to the health service.

But why should we let them off the hook? The answer is simple – for the national good. Just like the need to confront Brexit. And here’s the news: maybe the public are smart enough to recognise the altruistic effort without being bludgeoned by soundbite. Maybe they will reward after all the ones who had the vision and integrity to act before it was too late. Wouldn’t that be a prize?

CONSENSUS

Last word to my GP. The media have to take a huge share of the blame for where we are now because they constantly do down the NHS and those that work in it, especially doctors, and they crucify any politician who tries to suggest different ways of delivering the service. It’s time to call for a national consensus and to tell politicians to knock their heads together instead of using the NHS to score childish cheap points off each other. I am sorry to lump this on you but I care so dearly about the NHS and the principal of universalism that under-pins it.

*Disappointed to see Jo Swinson trying to carve out a Liberal-only position for staying in the EU and shunning everyone else. Claiming to be the only UK party that’s pro EU is cheap  and out of keeping with the times. Party before country is never a good look (as she did in voting with the Tories in the coalition on among others, tribunal fees)

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9 COMMENTS

  1. While I agree with all that you say about the lack of cross-party consensus, I have another take on the problems, illustrated by my own local GP practice.
    20 years ago my village GP practice had five and a half doctors all working the traditional pattern of on-call and home visit medicine. Then we had the new GP contracts negotiated by the Labour Westminster Government and the LibLab coalition, offering huge salaries and optional contracted-in services.
    Now we have 3 doctors, two of whom are 3 days a week, a nurse- practioner and a Health Assistant. The out of hours service is NHS 24 and there is little prospect of a same day doctor appointment.
    That GP contract was the start of the decline in primary medicine in Scotland. GPs on £100,000 a year might still be uncommon but that is because they can work part time for a very comfortable salary.

  2. Bill McDermott,
    I don’t disagree with much of what you say, but I do not see you putting forward any solution, or even amelioration, for this problem upon which the Scottish government could act under the present devolution settlement.

    Independence would be a step towards allowing a different approach.

    Staying in this septic Union can only lead to the collapse and privatisation of medicine in Scotland. I would be happy to detail why if you are interested

    If you actually have options the Scottish government could take now, under present powers and fiscal constraints I would very much like to hear them.

    Thanks for the analysis, Derek.

  3. For many years I have suspected that Scotland’s elite uni’s intentionally allocate the vast majority of student places on premium fee high demand courses such as Medicine to far higher-fee paying students from outside Scotland, and hence pay rather less emphasis to ensuring places for many Scots students. This is self evident from the names on graduation lists, with Scots in a minority year on year. The insistence on straight A Highers’ represents another needless constraint on Scottish students in my view. The 6 year Medicine course at Edinburgh involves annual fees for Scots of just £1,820 (set by Scottish Gov), for rest-UK students this rises to £9,250/yr, and for ‘overseas’ students the fees increase to an incredible £32,000-£49,000/year. Our self-regulated uni’s therefore seem to be going for the money, and meanwhile are not ensuring sufficient Scottish doctors are brought into the system, assuming there is a shortage, or intentionally taking the higher fee overseas students and giving them work here in preference to Scots that are excluded from the profession.
    http://www.ed.ac.uk/studying/undergraduate/fees?programme_code=UTMBCHBMDP1F

  4. I think there is an assumption by Derek that the tories care about people, they don’t!

    If you look at what they are doing to the English NHS and other English public services, it should be abundantly clear they do not care about people.

    brexit will hit the poorest and most vulnerable the hardest as they will pay for it, as they did the banking crisis.

    Scottish fishermen were promised the earth at the June election by the tories, control of fishing will be taken back was the message. Now today we hear of michael gove, the uk environment minister telling Danish fishermen they would still have access to Scottish fishing stocks.

    How can you trust the tories, you can’t and you should also be aware they could not care less about society, there position as the party of government in the uk is wholly down to the media and the incompetence of the labour party, who have the same brexit policy as the tories, shame on them both!

    • Scotland – accounts for one third of the GB land area, and two-thirds of the UK Exclusive Economic Zone. That is a large part of why they want to ‘keep’ Scotland a colony.

  5. Not a word on Independence from Derek Bateman. His whole piece is focused on knocking political heads together to save the UK from stepping over the precipice of Brexit, and for the Scottish Government to take on board the critics of NHS Scotland like the fatuous Rennie, the vacuous Dugdale, and the destructive Davidson. Jeez – when’d you give up on #ScotRef and an Indy Scotland finding its own solutions once it has its hands on all the levers of economic control, with the ability to prioritise health and education over the likes of Trident, foreign wars, and huge infrastructure projects in the south of England? A thoroughly pessimistic and disappointing article from a Scottish perspective.

  6. As far as Brexit goes,there is already a government of national unity at Westminster with Labour backing the Tories to the hilt.
    Here in Scotland,we have a similar arrangement between these parties but for different reasons.
    The real opposition will not be from politicians but from the money men when they realise that the maniacs are serious and seriously deluded.

  7. We have a supposed “nationalist” party that talks tough about being progressive and representing radical change, yet their elected reps tamely take their places at Westminster. They even support Royalty ffs. I’m increasingly convinced scotland will never really be “free”. It’s a fantasy that grew, understandably, during the excitement of the 2014 campaign.
    Nicola Sturgeon is no revolutionary.

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