A question of health: Q&A with opposition spokespeople

What do you see as the biggest threat to the health of our nation and what would you do to tackle that?

Miles Briggs (Conservative):

I think it’s now acutely obvious that obesity is fast-becoming Scotland’s biggest public health crisis, and sadly, all the statistics reinforce that trend. The number of children at risk of being overweight or obese in Scotland has reached a new record high and sadly, many of the positive interventions such as the daily mile are not really impacting on turning this societal trend around. I believe it’s vital that we look to the changes and often difficult solutions required to address this crisis, and to achieve that, I believe we need to put a P in our NHS and build a preventative National Health Service. That won’t happen overnight, just like Scotland’s obesity crisis hasn’t developed overnight. But there’s no point in just saying you want to see this transition happen, we need to put our money where our mouth is.

Anas Sarwar (Labour):

We all understand there is a clear link between mental health and physical fitness, yet 21st-century Scotland is gripped by a mental health crisis. It’s time for a generational shift in mental health services, and we need a government that puts the fight against inequality at its heart, not as an afterthought.

There are several practical steps to take: as a start, we should ring-fence mental health budgets to ensure the resources reach the frontline where they’re needed most. Early intervention is needed, giving children and young adults the support they need, before anybody reaches the stage of needing clinical treatment. That’s why we should also go further and guarantee access to a school-based counsellor for every pupil in Scotland, restoring the bursaries for educational psychologists, and developing a programme of mental health training for all staff in schools and those involved in delivering education.

Alex Cole-Hamilton (Lib Dem):

I think unresolved mental health issues are the biggest threat to our nation. We’ve really got our act together on things like detecting cancer early, linking bad diet to heart disease and understanding obesity, but suicide remains the biggest killer of men under the age of 50, one in four GP appointments are made because of an underlying mental health problem, and children are waiting two years for first-line treatment for child and adolescent mental health services.

Mental ill-health resultant from unresolved trauma is closely linked to alcohol and substance misuse, unemployment and a range of other social issues, all of which cause a tremendous and undeniable drain on the state.

Alison Johnstone (Greens):

Health and income are inextricably linked, so the biggest threats are ongoing austerity, and a growing low-wage economy based increasingly on insecure work. These create huge challenges, not least obesity and the development of non-communicable diseases like diabetes and cardiovascular disease.

How can we combat health inequalities in Scotland?

MB: The fact that people living in the poorest areas are twice as likely to die early is completely scandalous and deeply concerning. We have known for a long time about the health inequalities in Scotland but as a country, I don’t think we’ve really looked at how we can start to address these often generational and cultural health inequalities. I passionately believe the Scottish Parliament can work to deliver Scottish solutions to these inequalities. Tackling health inequalities in Scotland is a huge challenge and one that needs long-term cross-portfolio actions at all levels of government, as well as the support of all political parties in Scotland.

AS: Health inequalities are intrinsically linked to our wealth inequalities and so cannot be solved by the NHS alone. Instead, we need bold policies that seek to tackle persistent poverty in all its forms. This is why Labour wants to see the introduction of a ‘health inequality assessment’, not just for health and social care policies but for across all government action, from Scotland’s budget to housing, transport, justice and education. Tackling poverty and inequality in Scotland should be the first priority of this Parliament.

by Tom Freeman

Postcode lottery: tackling variation in health outcomes and the NHS

ACH: Higher investment in drug and alcohol services – the SNP cut funding to these by 23 per cent in 2015 and this has led in part to Scotland recording the highest drug-related deaths in Europe for two years on the bounce. Obesity is one of the most widespread symptoms of health inequalities in Scotland. More deprived communities have far less ready access to fresh ingredients locally, whereas there is a sufficiency of access to cheap, processed foods high in sugar, salt and fat. Coupled with a lack of opportunities for physical activity, the numbers speak for themselves. We have been talking about this for years, and if food manufacturers won’t reformulate, reduce portion sizes and adequately advertise the contents of ingredients, we may have to step in and legislate to that end.

AJ: With a proper living wage and secure tenancies in good quality housing, with affordable transport links, access to attractive greenspace and good leisure facilities.  There’s growing awareness that addressing health inequalities isn’t solely the role of the medical profession and this is welcome. Universal free school meal provision is a welcome step in the right direction for our youngest pupils, but we also need to ensure that all children can be involved in sports and outdoor activities. Providing better opportunities for people to walk and cycle will help tackle increasingly sedentary lifestyles, whilst also reduce air pollution. 

What impact will a ‘no-deal’ Brexit have on the NHS?

MB: Since the UK voted to leave the EU I’ve never denied that we need to make sure that our NHS is protected and any potential issues are mitigated against ahead of the UK leaving – that is exactly what Scottish Conservatives have been working to try to help achieve. Although the SNP and others are very keen to try to use the issue of Brexit as cover or an excuse for the NHS workforce crisis which has developed on their watch, the NHS professionals in Scotland I speak to are clear that the NHS workforce shortages didn’t start on 23rd June 2016, they have built up under this SNP Government over the last 11 years.

What matters to me now, and should matter to all of us lucky enough to have a role in trying to solve these issues, is how we resolve the crisis in the future and that means redoubling our efforts on what I call the NHS three Rs – recruitment, retention and retraining – to meet the now historic NHS workforce shortages and also look to the future models of care we will need to provide the world-class health and social care service we all want to see delivered to communities across Scotland.

AS: It poses a clear danger to our NHS. Regardless of the repeated attempts at reassurance from the UK Government, the truth is that the implications of a ‘no deal’ Brexit will be monumental. Many EU citizens are valuable members of our health and social care workforce but we are already hearing anecdotes of people leaving because they no longer feel welcome in the UK – or are uncertain about their future. We are already facing a staffing crisis within the NHS and limiting our ability to recruit from the EU will only exacerbate the issue.

Ensuring the availability of medicines in a ‘no-deal’ scenario is also a major concern as we import many drugs and devices, such as inhalers, from the EU. The Tories in Westminster have set out vague contingency plans for stockpiling but it remains to be seen how these will operate in practice or if they will be fit for purpose in Scotland. Then there are more long-term questions about how we will ensure timely access to new medicines.

ACH: The EU migrant workforce accounts for about three per cent of our workforce – in some disciplines it’s as high as seven per cent. If their status in Scotland is not assured then the loss of their labour would create the sort of shock that would be devastating for the NHS. Coming out of Euratom, which governs the movement of radioactive isotopes, could see a major threat to our ability to offer radiological treatments, whilst withdrawal from the European Medicines Agency could see Scottish patients denied access to potentially life-saving European clinical trials. The cold irony is that people who voted Leave thought they were getting £350 million a week and yet the reverse of that is true – it’s one of the many reasons we need a people’s vote on the final Brexit deal.

AJ: Our Health and Sport Committee report highlighted grave concerns regarding the negative impact on staffing a ‘no-deal’ Brexit will have. Attracting and retaining our talented staff is already a huge challenge given the demands on too many of those who work in our NHS today. The divisive rhetoric of the campaign itself, and the lack of certainty provided by the UK Government to EU workers in the health service is already fuelling shortages. This is before we consider access to medicines, research funding and collaboration.

What are the biggest failings/achievements of the NHS under this government?

MB: I think it’s important to look at the areas of our NHS where SNP ministers asked to be judged on their record and where they set eight key performance targets for NHS Scotland. Important targets including vital areas of how our Scottish NHS is performing on the ground, like A&E waiting times, cancer treatment waiting times, and child and adolescent mental health service waiting times. In office, the SNP has only met (just) one of the key performance targets which it set itself.

For patients, perhaps the key SNP pledge to consider is the Treatment Time Guarantee. It’s well known that the sooner someone starts treatment after being referred, the better their chances of recovery. Yet under this SNP Government, the referral-to-treatment waiting times have plummeted to their worst ever and the so-called ‘guarantee’ has been broken 134,000 times in the first quarter of this year, the biggest margin since its inception.

AS: The NHS achieves many miracles every day, from safely delivering thousands of babies to saving countless lives. However, this wouldn’t be possible without the hard-working and dedicated staff who have been taken for granted by the SNP government. The lack of robust workforce planning has been its biggest failing and it is overworked and under-resourced NHS staff who have had to pay the price. Because the government won’t listen, I set up a workforce commission to examine what needs to be done to ensure that patients can receive the care they deserve.

ACH: Biggest failings: The SNP knowing about the crisis in mental health and failing to act, to put a counsellor in every school, to adequately train frontline staff and to invest in both child and adult psychiatric services. Cutting funding to alcohol and drugs partnerships by 23 per cent only to have drug deaths rise by 23 per cent – the highest in Europe two years in a row. Allowing the national mental health strategy and the suicide strategy to expire and then not replacing them for 16 months and 19 months respectively. Not investing enough in social care, not making a career of choice, meaning there isn’t enough of it so that patients who could be supported to leave hospital can’t do so, causing an interruption in flow throughout the rest of the service. Giving tens of thousands of patients’ false hope by sending them a letter saying their treatment would start within 12 weeks, as per the law, only to be told after that time that they were always going to have to wait 40 or 50 weeks.

Achievements: Our hugely talented staff, right across the NHS, who turn up for work, day and night and deliver a first-rate service in exceptionally difficult circumstances.

AJ: Waiting times for, amongst other services, mental health, are an ongoing cause for concern, and an example of the challenges of keeping up with the hugely increased need for certain services. Our rapidly ageing society places increased demand on the service, yet our NHS strives to respond to this each and every day, from within our local GP surgeries to our largest hospitals. It’s absolutely essential that government and parliament ensures that our NHS has the financial and human resources it requires.

If you were to work in the NHS, what job would you do?

MB: I suppose having been vocal that it’s time for Scottish males contemplating a career choice to “man up and go into nursing”, I’d better do the same and say nursing. I think for too long young men have avoided professions which were historically seen as only appealing to females, such as nursing. And I totally think we need to do more to encourage more men to consider nursing as a career path in the NHS.

AS: I already have! Before becoming a politician, I worked as an NHS dentist in Paisley. My wife still practices, so we are very passionate about healthy teeth in our household. I was always drawn to public service when I was growing up, and I saw dentistry as part of that.

ACH: I love working with kids, I was a youth worker for 19 years so I’d like to work in paediatrics.

AJ: I’d like to be a physiotherapist. From tackling incontinence to providing rehabilitation after falls, physios do so much invaluable work dealing with acute and chronic conditions, but are often undervalued and lack the recognition they deserve.  I’d find working in a discipline which offers a non-invasive and empowering response to health issues very satisfying. Physiotherapy is key to a preventative approach to health and should be easily accessible to all.