Carry On Kezia

None of this Sturgeon’s 100 days in Office pish from me. It’s a total media fabrication that means nothing. I am asking though if we can do politics differently for a change and actually improve public services.

The NHS ‘crisis’ is a case in point. Here we see the classic ritual dance – you go left and I’ll match you, lean the other way, and I’ll follow. Then we go round in circles and eventually fall down exhausted with no advance on understanding or development of delivery to the paying public. (The answer if you’re John McTernan in Murphy’s office is to privatise the lot and leave it to the market…brilliant)

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There is no NHS crisis, I’m sorry to have to tell you doom-mongers. But there are lots of mini crises in doctors’ surgeries, clinics, hospitals and outpatients’ and very definitely in the management executive offices of the administrators charged with steering the runaway train.

There have always been such crises and there will always be crises because the NHS is an anthill teeming with activity, constantly reassessing in light of events, learning by mistakes and determined to try and get it right. It is also infected with low morale and downright callous people of a kind you might encounter just about anywhere in our routinely inarticulate and occasionally fierce wee country. (Like the nurses who told a woman in her nineties to ‘clean it yourself’ when she said the toilets needed washed).

Everybody in the health service knows this and deals with it as best they can. What they don’t do automatically is blame the government because they don’t have time to spend with a needy patient or because they’re on-shift at the weekend again. They wrestle instead with heads of department and managers and expect it to be run more smoothly but, like drivers in a jam on the A9, they don’t immediately think it’s the fault of the Transport Minister.

Ultimately the chain of command leads back to St Andrews House, it’s true but there are in the region of 25,000 admin staff in the Scottish NHS http://www.isdscotland.org/Health-Topics/Workforce/Publications/2013-11-26/2013-11-26-Workforce-Report.pdf?10242861510 with salaries ranging from £43,400 to £174,000 http://www.sehd.scot.nhs.uk/pcs/PCS2013(ESM)03.pdf

whose job is to make it run efficiently before a report drops on Shona Robison’s desk.

I worked in the public sector and rarely did I blame the Culture Minister for arranging inconvenient shifts at BBC Scotland. I don’t mean it’s not the government’s responsibility (in England they’ve specifically said it ISN’T the minister’s job, a la McTernan) but that the government lays out the strategy and it’s up to managers and staff to get on with it, including allocating beds.

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If winter conditions cause a flood of confinements, whose job is it to unearth an extra 20 beds at short notice – the minister’s? You can argue the funds should be there although I doubt if anybody can properly predict need except basing it on precedent. But surely allocating budget need is why there are accountants in the admin block and executives with big desks…

Is missing targets guaranteed by legislation a crisis or a self-imposed PR gaffe created by a politician’s desperation to be seen acting in the public interest?

The point is that these are all long-term, unavoidable issues that have recently been conflated into a bigger ‘crisis’. It’s in the Record, it’s asked at FMQs and the Labour canvassers are handing out the leaflets on the doorstep all bigging up the NHS failure.

Labour’s strategy was ruthlessly exposed when they rushed in to attack the NHS with inaccurate figures on cancelled operations. It’s a scam and public confidence in the NHS and the SNP’s credibility to run it prove the point. I sometimes wonder what the staff make of it all.

What to do? Well, instead of putting on her starey eyes and her ‘Ah’m no kidding’ voice, Kezia Dugdale at FMQs might like to offer a solution. So far we’ve heard an extra 1000 nurses – a nice round sum, no? Why not 500? Why not 2000? Where would they go? Would they get specialist training? Why not 500 nurses and a few dozen consultants that we need? What’s the priority? Would they have a mobile bed centre for the winter seasonal rush? Or build more care homes for those well enough to leave but unable to fend independently? How would they deal with poor decision-making by managers? Would they toughen the disciplinary regime to make it easier to sack poor performers? What would they do when the whining stopped? Is stamping a foot really all she can do…or is there a young/feminist/progressive angle that one of her generation can finally bring to our debate.nurse1

 

Just as the SNP endlessly praise the service, giving the sense that there’s no need to worry, so Labour destroy the currency by running it down.

I suggest we stop the Carry on Nurse routine and invite Labour into the decision-making process. Seriously. The opposition nominates a representative, presumably Jenny Marra, who is invited to take part in all government discussions about the drift and range of health provision in a cooperative spirit to have Labour input at an early stage of policy planning. That way they get a chance to influence, they can see precisely where the challenges are and can appreciate where and why they disagree and can refine their arguments accordingly. No opposition person can be held responsible for any decisions made and is in no way held accountable. It’s a no-lose proposition. And it’s constructive.

It provides dialogue and perspective and deepens understanding. It might lead to the end of the shroud-waving embarrassment of Labour’s PR offensive. Think Labour would go for it?

It would be a nice way to mark 100 days of Sturgeon. Better than: You done OK, hen

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37 thoughts on “Carry On Kezia

  1. majormacbloodnok

    Nice idea but won’t happen. Co-opt Labour and they then won’t be able to use the NHS to try to use it as a stick to beat the SNH with. Mind you, even when they are involved they do have a tendency to go along with it as long, as they are free to vote against their own amendments later out of stupidity and spite. Hell mend them.

  2. What the major says.

  3. Alasdair Macdonald

    Like the previous poster, it is a nice idea, but it seldom works unless the invitee is sincere about the issue. Lyndon Johnson once couthily said it was better to have J Edgar Hoover in the tent pissing out than outside the tent pissing in. I suspect that if S. Lab were invited into the tent they would simply take the opportunity to piss in the places they could not reach from outside. S. Lab wants power for the sake of having power. Getting power is an end in itself and not as e would like it to be – a means to an end. There are some people in Labour who are motivated by the common good, but can we seriously say that about the likes of Jackie Baillie, Kezia Dugdale, Jenny Marra, Iain Gray and Jim Murphy?
    Labour set up the parliament so that it had to be consensual, but it filled it by and large with Numpties and quickly stabbed people who showed consensual tendencies – Henry McLeish, Wendy Alexander (yes!), Susan Deacon (despite her co-mortgagee).

  4. Bugger (the Panda)

    Aw OK, the Major is Double Plus Good/

    He appears to have been sober and I, well it is Poets Day.

  5. Hamish Henderson

    Invite Liebor in to a committee and expect them to be consensual, do you still believe in Santa?

  6. It’s still a good one to chuck out there though, turns the gas down to a peep when Kezia stands up, “you were invited to help get it right , you declined, what will the people of Scotland make of that !”

  7. What Deppity Dugdale and her predecessor Branch Managers fail to grasp is that they are not only supposed to constructively oppose government policies they regard as flawed, but they are also supposed to demonstrate they are competent enough to be regarded by the electorate as an alternative government-in-waiting.

    Currently Labour’s attitude to the SNP is so tribal they are still unable to accept the fact that the Scottish electorate voted the hated SNP into government in 1997, and then gave them an absolute majority in 2011 – which the PR voting system was specifically put in place for the Holyrood Parliament to avoid ever happening. So any hope that the current Labour leadership will act in an adult way and ditch their “SNP bad” attitude to everything, is based on the same level of belief that fairies and Santa Claus are all real.

  8. If what I saw on the news the other day comes to pass then we are in for interesting times.
    The proposal is to devolve health to cities in England this year and claimed that it would happen in Scotland next year!
    Imagine,all these Labour controlled councils being responsible for managing a health budget and service provision.
    Not an inspiring thought.

  9. Think labour would go for it. In a word NAW.

    You have to remember Derek SNP bad, very very bad. That’s all they have to contribute.

  10. Mostly I’ve for gotten all my Economics stuff, however Inflexible/Insatiable Demand comes to mind – you can never meet all expectations.

    Also Queuing Theory – what are reasonable affordable, quantifiable resources, and acceptable waiting times for delivery of services.

    The nurse/actress saga over at Wings surely isn’t over her wearing an NHS uniform to promote a Labour leaflet but that she simply doesn’t have any understanding of resource allocation and management, or she doesn’t care and that her career ambition lies elsewhere.

    Scottish Labour do also seem to neither understand nor care. Why else employ McTiernan, MacDougall, and Murphy? And their career ambitions? Power.

  11. Labour don’t seem to have any ideas or solutions to anything. That’s why all they do is deride what has been done. Easy to say ‘ this isn’t working” if they don’t have to offer alternative

  12. lastchancetoshine

    “Labour canvassers are handing out the leaflets on the doorstep”

    The postie brought mine, I’m pretty sure Labor can’t muster the people power in needs these days without resorting to the Royal Mail.

  13. Labour are involved in the decision making – take for example the case of Greater Glasgow and Clyde Health Board – there are about 6 Labour councillors on that board (earning an extra £6k) who are meant to run that health board – strange how Dugdale’s attacks forget to mention that Labour have as much direct influence on the routine activites of that health board than the Scot Gov Minister.

  14. I followed the link to the workforce pdf and can’t find the figures you refer to NHS Scotland admin salaries starting at £43k. I’m top of Band 4 in NHGSGGC, there are very few band 5. I’m on £22k pro rata and can’t go beyond it unless I movie out of admin. If you have definite figures please let me know,

  15. Labour’s constant run-down of the NHS in Scotland piqued my curiosity the other day, so I started to do a little digging in to Labour’s own record when it came to running the NHS.

    I found that when it came to bed-blocking, the SNP may be seeing a 4-year high in the number of patients waiting to be discharged, but my God it’s nowhere near the insane levels we saw under the Labour/LibDem Government.

    Also, 92% of cancer patients across Scotland received treatment within 62 days. A pledge that Labour themselves made, but never actually implemented their promised target for.

    Why is no mainstream media outlet covering this? All the information is there to find (you just need to spend several hours and go through a few cans of energy drink in order to find it). You would almost think that they didn’t actually want people to know the truth…

    https://myweemusings.wordpress.com/2015/02/27/its-the-general-election-stupid/

  16. Yes, my postie delivered that Labour leaflet to me too: it now adds colour and festive cheer to my recycling box.

    As for Derek’s points – yes, yes and thrice yes. Indeed, why blame the transport minister for the delays to the no. 63 bus timetable caused by snow. Labour knows that, and they know we know that, but they’re banking heavily on the propensity for some to grumble and blame without picking their targets properly. Rather like Murphy trying to whip up a bit of class war with the rugby / football thing, because he banlks on appealing to the worst that there might be in people. Divide and rule – aren’t we better than that? That’s Westminster’s way – stabbing each other in the back and setting people against each other, rather than just being open and honest. But then, it’s all about power and control isn’t it.

    I yearn for the day when Labour MSPs quit bitching about the SNP and instead listen to their constituents, who are by now heartily sick of the toy-throwing and pram-shaking and who expect constructive behaviour – as demonstrated by the party those constituents now appear to be flocking to. Did Nicola not extend the invitation to cooperate? Yes. Did Kezia and her pals accept? They did not. Ruth appears to have done so on at least two occasions that I know of and most probably more – what a pity Kezia doesn’t have permission from London HQ to do the same.

    • Great article and replies. I too am sick of hearing the word crisis, but more so of the BBC Scotland promoting it with irrelevant conclusions from their freedom of information requests purely to generate a story and allow Jim CRISIS! Murphy air time.

  17. Steve Asaneilean

    Well as someone who works in the NHS I think Derek’s thoughts are heading in the right direction.
    We desperately need a national conversation in Scotland about the future of our NHS and it needs to involve all of us.
    At the moment we are heading to cloud cuckoo land with mega fuss being kicked up over every new drug that can may prolong someone’s life by a few weeks but costs £100,000 – that’s money that has to be taken away from something else in the NHS because it works from a fixed budget.
    There is a vast difference between the health service people want and what they actually need. But beyond that there is currently also a gap between what is needed and what can be afforded.
    Hence we have demand exceeding capacity resulting in delays and blockages.
    The NHS has NEVER been properly funded and it continues to provide a great service on what amounts to a shoestring.
    So, for example, we have what is widely regarded as one of the best primary care systems in the world. Every single person in Scotland has the right to be registered with a practice – even if they are the sole occupant of a remote island. The average person sees their GP nearly five times a year. Primary care has 90% of patient contacts and does that on 9% ot the budget. The annual cost of this to the taxpayer is less than £200 per annum. Try finding a private health insurance that will provide you unlimited access to primary care for less than that.
    We need to depoliticise the NHS. Derek asks what those of us who work in the NHS want. We want to be left alone for a couple of decades, free from perpetual reorganisation. We want to get rid of meaningless targets. People should be prioritised according to need – and that is a CLINICAL decision – not a political one.
    We need a service based on safety and quality and evidenced-based care.
    And we need to be adequately resourced to do the jobs we have been trained to do. That can only come about through higher taxation and the sooner we grasp that nettle the better.
    The current NHS is not just the responsibility of SG – it’s the responsibility of all of us and Labour need to stop weaponising the NHS.I for one find it thoroughly demoralising. .

    • Thank you for that, Steve. You outline the best possible solution. I, for one, am very willing to pay more tax providing that it is contributing to appropriate funding for our wonderful NHS.

  18. Another good dissection Derek and capped with a good suggestion.

    Labour however, well they won’t bite. If there’s one thing they have proven beyond measure over their decades of control in Scotland, its that with very rare exceptions among their ranks, they don’t play well with others. They need perceived chaos and carnage to use as political currency and where none or in this case, where little exists, they create some.

    Who knows how much damage they have done with this current contrivance between politics, public and service? But make no mistake, they have wilfully and with deliberation caused damage, all with the intent of electoral gain. I doubt that public well being or confidence in their health service factored at all in the campaign office when Ed and his franchise heads decided to ‘weaponise’ the NHS.

    • Bang on Sam.

      And indeed all the comments.

      I want Labour wiped out in Scotland. I cannot see the people of Scotland trusting ANY of them. And J Marra for goodness sake is a puppet who cannot speak her mind. Only one liners , party lines. She cares nothing about the SNHS.

      labour and they’re brand of politics is outdated and irrelevant . The referendum changed everything in Scotland. The aim of most of us is to remove the liars from their comfy jobs. Not offer them a place at the table.

      labour is the shackles that bind Scotland to WM.

      Push hard and vote the buggers out. EVERY LAST ONE OF THEM

      I wouldn’t trust them to tell the time without blaming SNP for making it hard to read the second hands.

      SNP BAD ??? Labour WORSE.

      Workfare for all troughers

      • Strangely Ricky I don’t want them wiped out, I want them to change, to return to the task they were created for. How and ever that will not and cannot happen whilst Labour in Scotland is directed as a branch office of Labour UK. Labour UK are establishment through and through. Their captains in the accounting unit are placemen and women bought and paid for (mainly with our money) and they are fully wedded to a system of government which isn’t broken, but wilfully managed to allow manipulation of the electorate and their politics.

        Labour in Scotland needs to have its power base removed which will hopefully allow their core vote and membership the opportunity to clean house and lose the Westminster careerists. LFI during the referendum showed them the path and those people are still out there. This election and an SNP surge may give them just opportunity they require to do that house cleaning work.

        Here’s hoping.

        In the meantime we need to send down as many SNP MPs as is humanly possible to Westminster in May. They will be our only protection from the worst excesses of austerity economics.

        • I usually agree with you Sam it;s just i cannot forgive them for the abuse during the referendum, the constant lies and spin and anti-Scots rhetoric made me realise they are not the party and the people we need . they are troughers through and through.

          Worse is the “we’d rather have a tory than SNP ” brigade. How can anyone trust fellow Scots who do this.

          They will never change in my mind. They will tell you they will and then shaft us like they have done for decades.

          And no sooner was the referendum over and the LFI were back on the songsheet ripping into the SG . Why didn’t they rename themselves the independent Labour party instead of returning to the fold.

          Two weeks after the ref i had the same LFI supporters delivering Slab material full of the lies we already knew. These buggers went back to their day job.

          No doubt there are good folk out there but i will never trust them again. Even in an indi Scotland.

          I canny forgive them . Sorry.

          • Its understandable Ricky, there’s a lot about Labour to mistrust, however you won’t make all Labour support advocates of the SNP , Greens or SSP. They will simply always be Labour, but hopefully a Labour open to change as were those folk during the referendum.

            The best we can achieve in such an instance is to convince them to clean their own house and come along with us. It’ll take them some time and it’ll take no little effort from us too. As you say, we’ve a lot to forgive parliamentary Labour for.

            We can do it. 🙂

          • Oh, and by we can do it? I mean convince people to come on the journey. Forgiving Labour MPs is beyond even my patience. 😉

  19. I will just invent another crisis – it’s what I usually do

    • As long as you remember to report it factually, without invention.

      • Sadly Kailyard, if only it were so simple. But it’s not enough just to report facts – it’s how you present them that counts.
        The BBC has form here. In early 2012 they made much of paper in the Journal of the Royal Society of Medicine which showed a “significantly” increased risk of dying within 30 days of admission if you were admitted on a Saturday or, particularly, a Sunday compared to being admitted on a Wednesday.
        For every 100 deaths within 30 days of admission on a Wednesday there would be 116 deaths among patients admitted on a Sunday.
        But the reality is that out of a total of 14.2 million admissions looked at the overall death rate was just under 285,000 which equated to about 2% of total admissions.
        If a Wednesday admission carried with it an “average” 30 day mortality rate of 2% then a Sunday admission would carry with it a risk of 2.32%.
        Or, to put it another way, if your were admitted on a Wednesday your chances of still being alive after 30 days would be 98%. But if it was a Sunday your chances of still being alive in 30 days would be 97.68%.
        When put like that it seems to me that there was little to be scared of. Yet this is not how the BBC dealt with it or reported it.
        Then two days before the referendum vote they splashed on a £450 million deficit in the Scottish NHS budget. But the figure was never presented in context. It was based on a paper dated 6th August yet, mysteriously, it only appeared, courtesy ofan un-named whistleblower, within 72 hours of the referendum vote – so no ulterior motive there then.
        The reality is this paper told us nothing new. Throughout the last 30 years there has been an annual barrage of calls that the NHS is bust and needs to save cash – usually true of course! Indeed, since its inception in 1948 it has never been properly funded.
        In Edinburgh 25 years ago as well as the Western and the Royal Infirmaries there was the Eastern, the Northern, the Royal Victoria, the City, Bruntsfield, Simpsons, Longman, Elsie Inglis, Leith Hospital, etc. All these other hospitals have gone.
        This paper was looking at proposed developments in NHS Scotland and anticipating a funding gap for these of up to £450 million if they all went ahead. It was a discussion paper and nothing more and no-one disputed that. In contrast, at the same time, NHS England faced an actual deficit of £1 billion.
        The crisis in A&E, if there is one, is largely based on the nonsensical use of a self-imposed target of no clinical value. The key to effective A&E is good triage – sieving and sorting – and this needs to happen quickly to ensure that the sickest are treated first. Triage should happen within a few minutes of arrival and only takes a few minutes to do. Thereafter if your complaint is minor you may have to wait a long time to be seen – there is nothing inherently wrong with that in my view.
        In addition people may have been dealt with but then have to stay for a period of observation which may be several hours – again nothing wrong with that.
        But sometimes delays are nothing to do with A&E – they relate to lack of hospital or care home beds or lack of willing relatives to take someone home.
        It would be nice to stuff every A&E with lots of nurses and doctors but by its nature A&E is unpredictable and there is no use having lots of highly trained staff twiddling their thumbs. So staffing levels have to be judged on average demands – but this means some days demand will exceed the capacity to cope and other days it won’t. There is no clever way around that.
        I think it is appalling that any politician would seek to gain political capital out of a hard-pressed public service. As I said above, just give them the resources they need, as far as these can be afforded, and let them get on with their work.

  20. It’s an interesting point Derek but Labour already have influence over ‘ the drift and range of health provision’ it’s called PFI . By committing NHS trusts to paying millions , not just for this year but in some cases the next 20 years , every budget , every plan , every persons future using the NHS in Scotland is effected.

    Something Labour seem to overlook in their sound bite 1000 nurses nonsense.
    Twenty five years paying PFI or 1000 nurses ? Or lets put it another way , how many nurses , doctors, drugs, beds, services, equipment, transport v PFI

    No for my money (and my future grand child’s who will still be paying PFI) Labour have had enough influence and that’s before I start on the toxic Miss Baillies utter rings

    • Good point. PFI costs for ERI approach £60 million a year in Lothian out of a total budget of £1.4 billion for NHS Lothian. The PFI is due to run for another 25 years at least and we’ll not even own the hospital at the end of it.

      Not sure about the Forth Valley Hospital. That was more recent, and its PFI deal might have been under the Scottish Futures Trust.

      Recently Scottish Water was part privatised, under a bill introduced by Labour in 2005 which came into force in 2008. The part that was privatised is the supply of water to businesses, including hospitals. Called Business Stream. Furore this week that the contract which is to be renewed, might be given to tax-dodgers Anglian Water.

  21. Will Labour go for it? Will they funk! And how sad is that. To have the opportunity to do something good they’d rather sit it out so they can shout from the cheap seats that the SNP have caused this so called crisis.

    Haven’t FOI request gone up by 700% since the SNP came into power because Labour are looking for any crumb that they can throw across the benches to keep up their SNP bad routine? I’m sure I heard that somewhere.
    Arseholes!!!

  22. Re – Bed Blocking – Long before we had an SNP Government successive governments both Tory and labour were responsible for closing the Convalescent and Geriatric Hospitals and furthermore decreed that new hospitals (built and operated under the disastrously expensive PFI Schemes) should have fewer beds than the old hospitals such as the old Edinburgh Royal .

    Therein lies an explanation for the current bed blocking problem which of course is painted as ‘all the fault of the dastardly SNP’ by BBC Murphy and its star Labour supporter Eleanor Bradford ably cheered on by the Bird creature.

    • Steve Asaneilean

      @gus1940 – the new RIE is a good case to highlight.

      I was working in the old RIE in the run up to the new one being planned and built.

      At the time I had a number of chats with management team members who were involved in designing the new hospital.

      One of these conversations has remained with me ever since.

      I had heard that the new RIE was to have only 80% of the bed number of the old RIE. When I asked why I was told it was based on the average bed occupancy of the old RIE which was around 80%.

      I tried to explain that this was frankly nuts. The average might be 80% but that means some days it might have been 70% and on others 110%. Moreover even if it was 80% every days it was never the same beds in the same wards that were vacant.

      Sadly my view was laughed away. This reduction in RIE beds was also occurring when so many other hospitals in Edinburgh were closed. So there was simply never going to be enough beds and recurring bed crises were inevitable.

      This whole process was overseen by the Labour party but it is the current SG which is having to deal with the fallout.

    • I am told that the NHS no longer recognises the concept of convalescence. Hospitals are only to be for acute patients, and non-acute patients are to be cared for at home ‘in the community’ with a care package as soon as they have passed the acute stage. Except there aren’t many care packages available, most that are, are unsatisfactory, so bed-blocking is the result.

      Quite who makes these decisions isn’t at all transparent.

      I did do a bit of research into this once. This is what I found out.

      Ministers are advised by policy-makers. Policy-makers seem to be self-appointed experts working in the civil service. I don’t know quite how you become one. But when you look into the background of these boffins, their CVs, it turns out very few if any of them have had any clinical experience. Their degrees are not even medicine related for the most part. Some of them have moved to health management and policy from different areas entirely. They go to conferences here and abroad where they speak to other boffins, and they invent models about NHS delivery and outcomes. Blah, blah. There’s a whole culture of detached experts speaking to other detached experts. In the abstract. Blah, blah. They all tell one another how wonderful they are. Blah, blah. And their models, which have fancy names. Ministers fall for their guff. Because they can produces screeds of guff to back it up, from all the foreign conferences they go to. Ministers are awed by this pseudo-expertise. Especially if they hear it saves money. But they have no objective basis to judge.

      It seems that the idea of a convalescent hospital is out of vogue. But boffins have not stopped to ask why they were ever in vogue, and if those conditions still apply.

      Essentially it has to do with housing and social circumstances. In 1900 people were living in overcrowded housing without adequate sanitation. A non-acute hospital was a space between hospital and home, between sickness and full health, where those recovering but past the acute stage could heal and relax and not be a burden on their families unable to cope with them in their constrained circumstances.

      Today, housing and social conditions still apply, though circumstances have changed.

      For how many houses are adaptable to becoming mini-hospitals? How many homes are without downstairs bathrooms and bedrooms? How many showers are adapted to those with limited mobility? How many people live in flats without lifts? How many doorways are wide enough for a wheelchair? How many bedrooms are large enough for a hoist? And how many people have partners able to look after them (unpaid) during recovery? Or a wide social network dropping in on them to keep them cheerful and motivated?

      The whole problem with high-paid boffins in robust health advising ministers on these issues is they haven’t a clue how the other half lives.

  23. The NHS in Scotland remains encumbered by lots of vested interests all seeking their cut of the pie within a culture which puts co-operation at a low value because not standing your ground means your budget is cut.

    At department level it is the lead consultant and his department manager who can wave the most shrouds who tend to get the bigger slice of the pie. At board level hospitals are playing the same game aided and abetted by local politicians (who are in it for political leverage and advantage for their ‘party’) a sense of political self interest which we see routinely at Holyrood where NHS Scotland is thrown to the wolves.

    The SNP’s plans to bring together social care and medical issues which delay patient release from hospital now has another set of vested interests and fiefdoms in local authorities seeking to protect ‘their budgets’, local patronage and political advantage – Council Social Work Organisations.

    The solution to the NHS in Scotland does not lie in making further changes to the front line services which interact with the patients but to clear out a system of management, political oversight and bayful influence which has more in common with the worst of Soviet Russia than a modern health care system.

    NHS Scotland’s performance can only be assessed by its ability to meet objectively evidenced patients’ needs rather than expectations of vested interest groups and politicians, no matter how well meaning.

    The health care professions in Scotland are expected to provide care based on objectively evidenced, best practice is it not about time the politicians and management of NHS Scotland should have to do the same?

    Targets are ‘expectations’ not ‘needs’ and by definition they are to be aimed at, not achieving them is not a ‘disaster’ it is an opportunity to improve, to find better ways of providing care and not, as is at present, a Humpty Dumpty world of words meaning whatever the current political Humpty Dumpty decides they mean.

    If you want to know why nurses are rude the best place to start is to establish how they are being managed and treated in a situation of short staffing, extended shifts and the ridiculous restrictions operating in PFI hospitals imposes on their professional standards and sense of duty of care.

  24. Gus1940, SteveAsaneilean and Peter Thomson and myself are all saying basically the same thing; NHS policy is not being run by clinicians trying to meet clinical needs but by managers and policy makers without a clue about health care requirements and real people. Who exactly makes these stupid policy decisions like closing down convalescent hospitals or forcing mergers of other hospitals, reducing the total number of beds, and on what evidence and with what expertise, is not remotely clear.

    The politics of health requires more citizens to become actively involved in local community health partnerships and to challenge these decisions.

    As a community councillor I have tried to get involved in this but it is far more opaque and closed than local authorities are.

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