Spend Boris’s Billion On Health Reform

Earlier this week, the Auditor General for Scotland Stephen Boyle wrote powerfully about the continuing gap between ambitious policy announcements and actual delivery on the ground in Scotland.

On cue, we learned 24 hours later that the ambitious policy announcement by Nicola Sturgeon to create a new nationally run not-for-profit energy company had been scrapped – though not until half a million pounds had been spent on consultancy fees. That plan was the centrepiece of Ms Sturgeon’s SNP conference speech back in 2017. We taxpayers must hope that her speech at the SNP conference this coming Monday is less expensive.

The energy company idea flopped because it was a fundamentally bad one: as experts said at the time, a state-owned firm was never going to be a viable alternative in the fiercely competitive energy market. But there’s a deeper problem here than just a politician in search of a clap line at party conference. 

As Mr Boyle argued, the failure to implement and follow through on high profile policy announcements is systemic. He examined why it is that the ten-year old Christie reform plan – the Scottish Government commissioned blueprint which proposed a complete re-engineering of public services in Scotland – had not been fully implemented (for more, read Douglas Fraser’s blog on the subject). Drawing on discussions with public sector leaders around Scotland, Boyle revealed that many of them “still don’t feel truly empowered or sufficiently emboldened to make the changes they think are needed to deliver Christie.” They do not, he added, “feel accountable for delivering change that demands different organisations work together.” The impression given is of a public and third sector which feels unable to take risks or innovate for fear of bad headlines and slapped wrists. It points to a stifling culture of smallness.

None of this bodes well for the many hugely ambitious policy announcements which the First Minister set out in her Programme for Government speech this week. And, as Tom Gordon points out in yesterday’s Herald, given the SNP also envisages leaving the United Kingdom in the next three years, when is it all supposed to happen? As the First Minister and her team strategize about Supreme Court challenges, referendum timings, and independence rallies, it’s easy to imagine the temptation to revert to the tried and trusted governing method: play it safe, keep things ticking over, try and stop bad stuff from hitting the press. Instead of grasping the thistle, the policy agenda points to thistle avoidance.

Still, presumably the Sturgeon government would like to be remembered for doing something brave and long-lasting. Can it now?

It does, after all, now have some money to play with. As has been pointed out many times, one of the challenges of long-lasting reform is that while it requires up-front spending to enact, any savings from are only likely to be made up over a much longer timescale. So, even if it works in reducing demand and costs, there’s still a long period where you are paying for your reform package while your day to day spending is still spiralling ever higher. Take drugs. Campaigners say that if we’re to cut drug deaths and the huge cost to the taxpayer that drug abuse incurs, more money should be going into expensive rehabilitation and respite care to help people deal with the underlying causes that have led them into addiction. They make the correct point that this investment pays off in the end. But any impact takes time, and during that time, the state is still having to cover the huge cost incurred to the NHS, to social care, and to society at large from the abuse of drugs as things stand.

The Christie plan coincided with the onset of austerity Britain. But now the spending taps are back open. The Scottish Government announced last week that investment in frontline health services would increase by 20% over the lifetime of this parliament, with the health budget due to be £2.5 billion higher than it is today. Furthermore, on the same day, Boris Johnson unveiled his new health and social care levy which is going to hand Nicola Sturgeon an extra £1.1 billion on top. The Scottish Government confirmed the following day that this too would be added to the health spending pot.

So – given the SNP has already set out its spending plans for the NHS, why not use the extra cash from the UK Government to set up a new Heath Transformation Fund ring-fenced for innovative, risk-taking, empowering reforms in health and social care? Rather than allow it to disappear into the NHS, use it to push the big reforms that might relieve pressure on the system in the long run.

Why not use Boris’s billion to make a bold statement– and show that ten years on from the Christie plan, the Scottish Government is going to put its money where its mouth is?

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