I VOTED FOR DEVOLUTION in 1997 from a sense of Scottishness and because I thought bringing decision making closer to home would improve our public services. But Scotland has never been so divided and unhappy and our public services are deteriorating.
I am a GP and in my professional opinion the SNP’s health record is lamentable. Here’s why.
The SNP formed a government in 2007. Nicola Sturgeon was the health secretary from 2007 to 2012. In 2008 the BMA warned that Scotland faced GP shortages. The warnings for Nicola Sturgeon were there right from the start.
Despite that BMA warning in 2008 the Royal College of General Practitioners predicts a shortfall of 856 whole time equivalent GPs in Scotland by 2021. The SNP focus on independence took precedence over everything, including our health service.
The Royal College of General Practitioners has long called for general practice to receive 11 per cent of the health budget in order to provide an adequate general practice service. In 2005 it was 9.8 per cent but by 2019 it had actually dropped to 7.35 per cent. Hard to believe – but true.
This underfunding inevitably had a detrimental impact on general practice – whole time equivalent GPs in Scotland dropped by 160 from 2013 to 2017. In 2018 25 per cent of GP practices had an unfilled vacancy.
The shortage of GPs had consequences. The number of practices that had returned their contracts to the health board, feeling unable to meet their obligations, was 59 in 2019. This was because they were not able to provide a safe medical service. Such a decision would have been an agonising one for every practice and the decision would not have been taken lightly.
We have even had GP practices closing completely in Scotland because of GP shortages. This has happened all over Scotland including Dumfries and Galloway, Ayrshire, Edinburgh, West Lothian, 11 surgeries in Grampian, 14 in Highlands and Islands.
I did my GP training year in Edinburgh in 1992 and I was astonished when I discovered that a 4000 patient GP practice in Inverleith Row, neighbouring my training practice, had closed in 2017. This would have been unthinkable in 1992.
The situation is not much better in hospitals. The current vacancy level for consultants in Scottish hospitals is close to 500. Health boards spent £102 million pounds on medical agency locums in the last financial year. That amount of money would pay for about 1000 permanent consultants.
I returned to Dumfries as a GP in 1998. At that time the hospital was full of long term permanent consultants. Now the hospital, and it is an excellent new hospital with excellent staff, has 22 consultant vacancies and the hospital spend on locums is 7 million pounds. That would pay for about 70 permanent consultants. And thank goodness we do have locums in our hospital, otherwise patient care would collapse.
The reason for consultant vacancies is multifactorial – the after-effects of the divisive referendum in 2014, higher tax rates in Scotland, uncertainty around a second vote on separation with the threat of currency turmoil, spending cuts and tax rises will all be contributing. Significantly the distinction awards budget was frozen by the SNP in 2010 with no new awards and no progression through the scheme. These awards are given to consultants for clinical excellence and are still available in England and Wales. Ambitious, highly motivated consultants from the rest of the UK are therefore deterred from coming to work in Scotland and potential Scottish consultants attracted to move south.
The high level of consultant vacancies nationally helps explain why the Scottish NHS missed 6 out of 8 national waiting time standards in 2018/19. The missed standards included Child and Adolescent Mental Health Service referrals seen within 18 weeks and patients starting cancer treatment within 62 days. This is not good enough. Young and old are suffering.
For the situation to change we need to look at how we choose medical students for Scotland’s medical schools. In 2000 the number of medical students in Scotland who were Scottish was 63 per cent.
By 2016 the number of medical students in Scotland who were Scottish had dropped to 51 per cent. This is poor planning because research shows that medical students domiciled in Scotland are twice as likely to stay and work in Scotland after graduation compared to students from elsewhere. The problem is that SNP policy means that universities receive more money from students from the rest of the UK or abroad than they do from students domiciled in Scotland. This results in fewer medical students staying to work in the NHS in Scotland after graduation.
In my own GP practice in Dumfries we have seen the consequences of SNP policy. We have had enthusiastic local youngsters come to visit our practice and they are desperate to study medicine. They have their five As at highers and they would make excellent doctors, but they apply to Scottish medical schools and they do not get in. This needs to change.
From my own point of view it was obvious what was going on in general practice locally. The stress that colleagues were under in practices locally where they were short of GPs was obvious. It was disturbing to witness.
It felt like the health service in Scotland was crumbling. And yet, even after the clear result of the independence referendum, the SNP was still parading around the streets, waving flags, when they should have been concentrating on the health service.
Belatedly some action has been taken but we should never have reached this point, where GPs are handing their keys back to health boards and practices are closing for ever because of a shortage of GPs.
The evidence also shows that the SNP’s response to Coronavirus has been poor. We have one of the highest number of excess deaths due to Covid-19 in the world. Elderly patients with Coronavirus being moved from hospitals to infect nursing homes was a deadly mistake. It is wasteful that the SNP has not availed of the expertise of Professor Hugh Pennington, the reason being he does not support the SNP. Nationalism damages your health.
The fundamental problem we have in Scotland is that we have a nationalist SNP government in power which does not believe in devolution; whose sole focus is separating Scotland from our family and friends in the rest of the UK. The health service, our schools, our police force come way down their list of priorities – and it shows.
What we need in Scotland is a government that wakes up in the morning and its first thought is how do we make Scotland better today, rather than how do we break up Britain. Devolution does not work when the government in power does not believe in it and has a motive to see it fail.
So it is time for change. It is time for a Scottish government that focuses exclusively on our public services. We would all benefit. We can have that government. It is tantalisingly close.
