“The winter of discontent was beginning to thaw and the life that lay torpid began to stir itself.” The hopeful words of Henry David Thoreau.
In 1845 he took himself off to live in the woods by Walden Pond, Massachusetts, and wrote one of the first “environmentalist” books in the English speaking world.
A visit to the snowdrops at Dawyck in the Borders this week gave me that same hopeful feeling that we are through the worst of winter. Easter is just over the Lenten horizon. My enthusiasm for spring even saw me plant a beech hedge in my back garden on Tuesday. The spindly twigs look so fragile, so torpid, but I eagerly await developments.
There’s no such long term thinking about our National Health Service. And that’s a point being made this week in the latest, and desperate, report on the NHS by Audit Scotland. It takes up the call already being made by the doctors’ organisation the BMA, the Royal College of Physicians and the Royal College of Nursing for a public debate about what the NHS should be providing.
After listing the well-known stresses on the NHS – long waiting times, shortages of staff, health board budget deficits, a huge maintenance backlog – Audit Scotland concludes: “there is a risk that Scotland’s NHS will take up an every-growing chunk of the government’s budget.” Already that stands at £19.9bn a year, or almost 40 per cent. What is needed, say the auditors, is “a long term vision for the wider health system that sets out national priorities.”
This is all a highly taboo subject for the politicians and, of course, they lack the courage to face it. Are there limits to the treatments the NHS should offer – like dentistry, or hip replacements, or expensive drugs or free prescriptions, or mental health services, or preventive medicine? Should we adopt an insurance model of health care, as in much of Europe or the USA?
I don’t suppose William Beverage, when he envisioned the NHS in the 1940s, ever considered that so many people would live into their 80s and that the treatments on offer would be much more than accident and emergency services and GP clinics. It was all going to be paid for out of National Insurance, not general taxation. He would, quite rightly, be shocked that the NHS takes up 40 per cent of the Scottish government’s budget, leaving other services squeezed like education, police and fire, transport, social services, waste disposal, arts and sport.
All our main political parties are pledged to an NHS service “free at the point of delivery” but they don’t define what that NHS service should be. They allow it to grow in the imagination of the public into “free good health for life” but then don’t fund it. So doctors, nurses and all health staff, are put under huge pressure to deliver the impossible.
In the absence of anyone else making any suggestions for reform, including the BMA and the Royal Colleges and, of course the politicians, let me mention three of my own. Prepare to be shocked.
We should pass many of the NHS responsibilities over to the Social Care service (whether national or local) and fund them through a retirement levy. These might include convalescence, knee and hip replacements, eye cataracts and end of life palliative care. Dentistry should be allowed to go private, with a subsidy scheme for those on welfare benefits. As for prevention services, these should be taken over by local council social services departments, funded by an increase in the council tax.
The council tax, by the way, is an overlooked source of council revenue. The amount raised could be increased by as much as £1bn a year, if the value of properties were up-dated. But the current SNP/Green government is heading in the opposite direction, promising a council tax freeze. It’s true it is offering councils a share in £200m compensation, but that only equates to a 5 per cent increase. So far only Argyll and Bute has had to courage to turn down the offer, saying it needs to increase council tax by 10 per cent to avoid cuts in services.
To me the brave councillors of Argyll and Bute are like snowdrops in the political landscape – harbingers of better times to come. I wish I could say the same about the other big political story of the week, the chaos at Westminster over the SNP’s motion calling for a ceasefire in Gaza. It ended with the SNP calling for the resignation of the Speaker Sir Lindsay Hoyle because he allowed their motion to be overtaken by a similar motion from the Labour Party.
The scrum on the floor of the House of Commons on Wednesday night will only be overtaken in my mind’s eye by the rugby game this weekend at Murrayfield between Scotland and England. Don’t tread on the snowdrops boys, for you tread on my dream of a fourth victory in a row for Scotland.
