Thursday, 29 September 2016

Scottish Government suffers NHS defeat

Something quite remarkable happened in Holyrood yesterday.

The SNP minority government experienced a rare defeat after all opposition MSPs united behind a Labour motion calling to protect local NHS services.

After the government's amendment, committing to "maintaining and improving safe and effective local services across Scotland" was defeated, the 62 SNP MSPs abstained from the final vote, meaning that the Labour motion was passed by a margin of 64 to 0.

Labour, the Liberal Democrats, the Conservatives and the Scottish Greens want the government to call in proposals affecting services across Central Scotland. What is particularly concerning is that proposals to reshape services could be made without ministerial approval, and the opposition parties believe this is an unacceptable situation. As Labour's Anas Sarwar said: "It would be a democratic outrage if we allowed health boards to proceed with these decisions without individual members of this parliament or indeed this minister having a say."

The health board proposals for service change affect maternity services at Inverclyde Royal Hospital and the Vale of Leven Hospital, children's services at the RAH in Paisley and orthopaedics at Monklands Hospital in Airdrie (all, oddly enough, places I've previously worked). Glasgow's Centre for Integrated Care and Lightburn Hospital could also be affected, with the latter potentially facing closure. There can be little doubt that much of the decision making is being driven by financial pressures, resulting in plans for increased centralisation of services.

It's very easy to jump on the emotive "save the NHS" or "keep our local hospital" bandwagons. I've done it myself when there's been good reason. But I'm also sufficiently aware that clinical needs are constantly evolving and therefore how we provide NHS services should, too. There are often perfectly valid clinical reasons for revisiting service provision. However, how we do this is vitally important and the process must be transparent and accountable. There has to be adequate consultation, and there must be opportunities for ministers to have a full discussion with, if necessary, the option to oppose such changes.

Cabinet secretary Shona Robison said it would be “inappropriate” for her to discuss the proposals in detail, or indeed whether or not she supports them. She did state there is the possibility that the final decisions could come before her for approval, but didn't make any guarantees. She stated: "Local people can be ensured that in all such cases, ministers take all the available information and representations into account before coming to a final decision. I think that is the proper and responsible way to run our health services." This was not entirely convincing,

Lib Dem health spokesperson Alex Cole-Hamilton said afterwards: "This vote sends a clear message to the health secretary that these damaging NHS closure proposals need to be called in by ministers and scrutinised by the Scottish Parliament." During the debate he had claimed it was "astonishing" that the issue was only discussed in parliament due to the opposition tabling a debate, and while recognising that "challenging decisions" needed to be made, called for Ms Robison to "enlist [MSPs] as champions" in redesigning health services.

It's extraordinary for anything to unite all the opposition parties in Holyrood, and this unprecedented (but not entirely unexpected) reversal for the government demonstrates the need to ensure it has the confidence of parliament. Some level of opposition support will always be necessary and the Greens cannot simply be assumed to offer it unconditionally. The outcome of the vote is not binding on the government, and inevitably uncertainty about the future of the NHS can unite across party lines in a way that other issues cannot. Perhaps it would be wrong to make too much of it - but the Scottish government was fortunate to narrowly avoid defeat (in rather bizarre circumstances) last week on its council tax proposals and this will be another shot across its bows. The Herald described it as "a bloody nose for the SNP", which seems to be overstating the situation, but the government will have had better weeks.

It's a good result in that it's sent a clear signal to the government that decisions affecting the NHS must be accountable and open. Whether the government acts on the vote is another thing, but I fully expect given the nature and sensitivity of the issue that it simply has to. Certainly, as a former Lib Dem member Gerry McGregor suggested, the result puts to bed the notion that the SNP government is effectively a dictatorship supported by the ever-compliant Greens. It's also positive to see the opposition parties working constructively to ensure democracy holds government to account - and for Labour to be showing a little of the kind of leadership we used to expect from them.


jonny said...

Only two
"Democratic outrage" from a bunch of list liggers.
Tories hammering the Scottish budget. Tories voting against rationalisation caused by said cuts. Hypocrites as usual.
As for the Greens, usual opportunists.
SNP bad and incompetent, all for your pals in the media. Stuff you Lid-Dem.

Anonymous said...

It is good to see parliament holding the government to account. In a minority government that is how it should be. We have been used to always having majority government in Westminster, and over the last years in Edinburgh too.

It's how it works, and it is good that it works. It can make for better government.

I take your point about the changing needs of health service facilities. It's important to remember the bigger picture when making this kind of decision, whether it be about hospitals or, indeed, other provision. Sometimes the very limited money that we have to spend on health can be better spent even if it means a facility closing. (Once upon a time we had massive psychiatric hospitals. Now they have closed and people are treated in the community.)

I wish, though, I could fully trust the opposition parties not to allow their visceral hatred of the SNP cause them to vote for political gain (and headlines in the Daily Express/Mail crowing that the SNP is finished because of one vote) rather than for the good on the community.

That's the wrong way to use the power that I think we all agree they should ahve.

Andrew said...

Jonny - it doesn't matter what the majority is. That's the arithmetic and a minority government has to work with it.

My post wasn't actually an expression of "democratic outrage" or even "outrage". Read it again. No, please do.

Collaborative approaches can and do work, and are particularly welcome where public services are the central issue. The opposition is to be commended for this, and I'm sure the government will also learn from the experience. This isn't an exercise in having a go at the SNP - it's about ensuring our democratic systems work in the public interest.

Where do I suggest the SNP are "bad and incompetent"?

I'm also not really sure where all the Lib Dems' pals in the media have been hiding for the last five years...

Tris - indeed, this is how it should be. Minority government can work, and this kind of situation can help create better government. I hope it will. I see sections of the media are presenting this in partisan terms as a reaction against the SNP, but I don't read it in that way so much as an attempt to ensure government accountability. And of course empower parliament to shape our changing health services.

We need to constantly review how we provide our health services, and of course there are financial pressures. What concerns me is when clinical objectives become sidelines in order to satisfy those financial pressures, as inevitably it's something of a false economy - storing up more troubles (and expense) for later.

I can't possibly speculate as to motivations, although there is a point to which all of the opposition parties (with the exception of the Greens) have defined themselves by being anti-SNP. In this case, working with the government to ensure greater transparency and more accountable decision-making, rather than succumbing to the temptation to score easy political points, would be the most positive way forward.

Al said...

It can be agreed that this is remarkable, but what is remarkable is the sheer hypocrisy of the opposition, and unionist parties in particular.

These proposals come from local health boards, not the Scottish Government. On many of these health boards, I understand there are often more representatives of unionist parties than the SNP has. In effect, unionist parties are complicit in calling for these cuts outside the Scottish Parliament that they are going through the charade of opposing within it.

But the worst hypocrisy comes from the Liberal Democrats. On other services, they criticise the Scottish Government for centralising decision making and taking decisions out of local hands and yet here they are calling for the Scottish Government to do that very centralising thing! Do the Liberal Democrats want the Scottish Government to prevent local health boards making proposals, because that is what they are now saying.

You will remember that two years ago, the YES campaign highlighted the threat to the NHS posed by a NO vote. The NO vote leaves the Scottish NHS vulnerable to cuts to budgets imposed by Westminster. Only a YES vote could have protected it. There are more cuts coming from Westminster on the way and Brexit, something else that a YES vote would have avoided, will likely make them deeper. With a few honourable exceptions such as yourself, the Liberal Democrats stood shoulder to shoulder with UKIP, the Tories and Labour to campaign for that No vote. It is time for them to accept responsibility for the consequences of the vote they campaigned for.

Anonymous said...

This looks like a plea for more centralised dcsion making - so long as it iis driven by the opposition parties and not just the SNP. Interesting discussion above through.

Andrew said...

Al - I see where you're coming from. I did mention that these proposals come from health boards and not from government.

I also believe that clinical decisions are better to be clinically led. However, when it is clear they are being driven largely by politically-created pressures and when parties have been elected on promises made on the shape of the NHS, there has to be some room for ministerial oversight. Opposing centralisation doesn't mean supporting a laissez-faire approach without accountability.

I couldn't comment on the make-up of health boards, although there is a distinction between members of political parties who may sit on them and those elected to serve as MSPs.

I voted YES as you point out - this was not due to threats to the NHS, although I was convinced the NHS in Scotland would be safer outwith the union. It naturally gives me little pleasure to have been proved correct. All this said, the main thing now is to work collaboratively to ensure the best possible health service provision for Scotland and to support heath boards struggling to meet financial demands rather than abandon them to the perils of short-term decision making.

I don't see this vote as an opportunity for some tribalistic one-upmanship over the SNP. I do see it as an opportunity to signal a forge a more co-operative cross-party approach towards the Scottish NHS.

Al said...

Andrew, we agree that the proposals come from Local Health Boards. If a proposal comes from a Local Health Board, I think we also agree that the Scottish Government should give it proper consideration. The Scottish Government has a procedure for considering such proposals that includes consultation and wider strategic considerations. It wants to go through that procedure, as would any responsible government, bearing in mind that any such Government decision that doesn't follow proper procedure and consultation could potentially be open to challenge by judicial review.

In contrast, the opposition parties want the Scottish Government to dismiss such local proposals out of hand if they involve closure of an existing facility. If a Local Health Board, being closer to local need, says that it could deliver its services more efficiently in a particular way that involves closing a facility shouldn't that get consideration? Are we saying that all facilities must always remain open no matter how outdated they are or how much local needs have changed? It may well be that after going through the consideration process, the Scottish Government decides for national strategic reasons or other reasons not to action such proposals anyway but surely it is only responsible government to consider them properly and irresponsible opposition to seek to prevent that. Finally, this isn't just about closures, remember how quick the opposition parties were to criticise when the Scottish Government opens new modern hospitals, such as the new one near Govan.