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.
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. *
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.
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.
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?
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)