Reality Check on the NHS: This Won't Hurt?
A third of Holyrood's budget goes on health, so where's the election debate about the future of the health service?
The pledges being made are towards the margins: Lib Dems want more efficient medicine procurement and capped pay, and there would be a small increase in income if Tories re-introduce prescription charges for some.
The biggest difference between Labour and the Scottish National Party on health is between Labour's promise to speed up the maximum wait to see a cancer specialist, while the SNP says the priority is to get Scots with cancer to their GPs at a much earlier stage in the disease's progression.
What they all agree on is protection of the NHS budget against cuts being imposed elsewhere. That makes perfect political sense, as the NHS is hugely popular, and cutting it would be hugely difficult.
It makes a bit less financial sense.
Ring-fencing one part of Holyrood's budget gives an incentive not to make efficiency measures that might be possible or desirable. It allows those within the service to expect continuation of the rapid rise in pay that several groups have seen over recent years.
But look at it another way. While the cash going into NHS Scotland keeps rising, the rise in real terms spending power has come to an abrupt stop.
Spending pressures have not.
Spending power
With the current financial year barely a month old, I'm reliably told that health boards reckon they face an overspend of around £100m because of ring-fenced money within their budgets and cash that's already allocated.
That may be modest, judging by an interview given by the chief executive of Greater Glasgow and Clyde health board.
Robert Calderwood told The Herald earlier this year that he's getting a 1% increase in spending power this year, but it's quickly wiped out by commitments already in the pipeline, amounting to between £45m and £51m.
Part of that is in the drugs bill going up, by between 6% and 9%. Unlike other sectors, the more you invest in health technology, the more your costs go up, and the more people's expectations rise of having access to it.
Audit Scotland recently reported the VAT bill is adding £23m to NHS Scotland costs, plus an increase in employers national insurance contribution.
It said there are "major challenges to find significant savings", even if the budget is protected from the cuts being felt elsewhere.
Older people
The pressure it highlights strongly is the demographic pressure on services.
That comes particularly from the growing number of older people, who use health services more, and the particularly rapid rise in the very old. Scots aged over 85 are due to rise in number by 144% by 2031.
Audit Scotland cites Scottish government analysis showing that the bill for health and social care for those aged 65 and over is around £4,800 this year, and will be up by about 15% by the end of the next parliament, in 2016.
By 2031, it is on track to rise by 62%. Simply keeping pace with general inflation isn't much of an answer to that kind of cost pressure.
Since Professor David Kerr's report into the future shape of NHS services in Scotland, his recommendation of centralising some services to improve their quality has been dumped in favour of protecting local hospital services. That's now common ground for the major parties.
So if hospitals are protected, what about jobs?
Compulsory redundancies
The political desire to avoid compulsory redundancies is described by one very senior health manager (they tend not to talk both candidly and publicly) as "completely unrealistic".
So if both hospitals and jobs are protected, then watch out for pressure being brought onto the relatively soft and less politically sensitive options of public health or mental health.
Or there could be a significance to the moves for health and social care to be merged. There are variations on that theme on offer in party manifestos.
In England, one way the government is handling the protection of NHS spending while others suffer is to give it more to do, such as taking on the healthcare elements of immigration and detention.
That might also be what comes out of a merger with social care, forcing the NHS to take more of the squeeze while making it look like a sensible piece of efficient management.
Inside the NHS, and away from the political consensus on protecting the total NHS budget, there's a lot of questions being asked about how sustainable the current model and expectations can be without big and difficult changes and reforms being required.
That's where Campbell Christie's commission on the future of public services, recently set up by the SNP administration, may provide some answers - when it's safer to debate these things, after the election.
Hullo, I'm Douglas Fraser, and I'm business and economy editor at Â鶹Éç Scotland. Welcome to my blog, where you can read my take on money matters, viewed from a Scottish perspective.
Comment number 1.
At 4th May 2011, spagan wrote:With Westminster's cuts to Scotland's budget, it is going to be a tough few years for all of us - including the NHS.
Important to blame the Tories and the Liberals - but they'll be covered by Private Healthcare.
Perhaps more important to blame New Labour and Gordon Brown for wrecking the UK economy and stuffing the spivs' and speculators' with their crazy PFI and PPP schemes.
In the short term, to illustrate that "we are all in this together" - the new SNP Government should ensure that nobody in the NHS earns more than the First Minister.
If a couple of surgeons decide to go to the States, so be it. If greed is their primary motivator, then perhaps they'll already be there?
In addition, Nicola Sturgeon should look at introducing the concept of an "approved list" for all NHS prescriptions. There are cheap generic medicines that are exactly the same as the branded equivalents - but hugely cheaper to the public purse.
As long as the list is approved and monitored by GPs there are massive savings to be made.
Sad reality is that we cannot afford to stuff the Drug Companies with funds that would be better spent on service provision.
Slainte Mhor
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Comment number 2.
At 4th May 2011, ziggyboy wrote:It is to be hoped that whichever party gains control in the election tomorrow that they pay proper attention to the NHS budget.
I have a friend who recently suffered a heart attack whilst on holiday in England and within a week was home having received the best of care. On returning home she was advised to contact her GP who would in turn contact the Cardiac Services and they would arrange for a nurse to make a home visit. The appointment was made for between 2 and 4pm on a particular day however at 2.45pm on the day of the appointment my friend was contacted by the nurse who said that due staffing difficulties she would not be able to keep the appontment.
Whilst my friend appreciates the need for budgets to be carefully looked at and managed she is dismayed to find that the same level of care does not seem to exist in Scotland.
I understand that had the heart attack occurred in Scotland she would still be waiting to have the angioplasty which was caried out within one week in England.
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Comment number 3.
At 4th May 2011, JayBee wrote:What is the SNP's policy for defence of the nation, if throgh independence, we split from the rest of the UK and how would it work?
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Comment number 4.
At 4th May 2011, kaybraes wrote:Hopefully the NHS will get back to treating the sick instead of empire building and running an ever increasing administrative monster which is swallowing funding faster than all the treatment of the sick ever did. Six figure salaries which appear now to be run of the mill in public services must not only be frozen , but must be reduced, and the numbers receiving them must be reduced. There is no good reason why public service executives should earn the kind of salaries that their limited talents could not earn anywhere in the private sector if indeed they could find employment in the private sector. Only when public services get back to serving the public and not their own ends will we get our bins emptied, our roads repaired and dare I suggest it, access to a NHS dentist.
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Comment number 5.
At 4th May 2011, AMJHAJ wrote:2. At 10:03am 4th May 2011, ziggyboy wrote:
Very sorry to hear baout your friend.
But you say:
"I understand that had the heart attack occurred in Scotland she would still be waiting to have the angioplasty which was caried out within one week in England."
Curious to know exactly how you "understand" that.
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Comment number 6.
At 4th May 2011, AMJHAJ wrote:4. At 18:45pm 4th May 2011, kaybraes wrote:
"Six figure salaries which appear now to be run of the mill in public services must not only be frozen , but must be reduced, and the numbers receiving them must be reduced. There is no good reason why public service executives should earn the kind of salaries that their limited talents could not earn anywhere in the private sector if indeed they could find employment in the private sector."
Evidence for this?
"Only when public services get back to serving the public and not their own ends will we get our bins emptied, our roads repaired and dare I suggest it, access to a NHS dentist."
Evidence for this? 1 million more people are registered with a dentist in the last four years.
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Comment number 7.
At 4th May 2011, spagan wrote:6 AMJHAJ
Correct re NHS Dentistry.
In the bad old days of New Labour and Liberal Coalition, there were queues of hundreds across the North and NE - trying to get registered with a Dentist.
4 years on and we have many more NHS dentists and some fantastic facilities.
Another major success story for the SNP.
On the £100K + salaries - way too many - and still too many layers.
Each Board used to have 4 Senior Managers (Medic, Nurse, Treasurer and Administrator). Larger Health Boards had a Chief Dentist and Pharmacist as well.
We need to get back to these less complex structures.
Most of the layers were brought in as Thatcher tried to bring in a "market" and a system where accountants ruled - pricing everything and valuing nothing.
Slainte Mhor
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