Closing down local hospitals on the grounds of efficiency is one of the most problematic decisions that any government has to make. Their very locality means they are sure to be defended to the hilt by campaigners and their MSPs; having a neighbourhood hospital is regarded by most voters as an absolute priority. One of the first announcements made by Nicola Sturgeon, health secretary in the newly elected SNP administration of 2007, was to reverse a decision by her predecessor to close the accident and emergency units at Ayr Hospital, and Monklands Hospital in Lanarkshire. She argued that not enough weight had been given to local interests. It was a popular decision, widely welcomed.
Now, as first minister, facing considerable overspends in regional health boards, and with the NHS in financial crisis, she is having to rethink that approach. Several things have dictated a reversal of previous policy. The first and most obvious is the need for efficiency. There is huge disparity in the size, expertise and resources of Scotland’s 14 health boards. Sharing more of those resources makes sense. It is true that, to an extent, this already happens. Spinal injuries are likely to be treated at the Queen Elizabeth unit in Glasgow; a heart patient may be flown to the Royal Infirmary of Edinburgh; Ninewells in Dundee has one of the best neonatal centres in the country. But there is a big jump to be made to the proposal that frontline services should be reorganised on the basis of three regions: west, southeast and north.
The second factor is savings. There is no question that closer working between health boards, if done sensibly, could be cost-effective. Modern communications make this feasible in ways that might not have been considered 20 years ago, and most reports on the future working of the NHS regard collective working as essential.
Finally, the interests of the patient should benefit from cross-board co-operation. Some boards, it has to be admitted, offer inferior standards to others. But it is surely the case that no one should suffer inferior treatment simply because of their postcode.
The Scottish government’s programme for greater co-operation is, therefore, a step in the right direction, however unpopular it is likely to be. There is a caveat, however. Yesterday’s report talks about centralisation, a word that has become synonymous with the present SNP government and is rarely accompanied by smooth working and greater efficiency. Bringing all services together, reporting to one single authority, is by no means a guarantee of immediate success. Police Scotland is one example where cost-cutting and centralised budgets led to a deterioration of back-office functions, and where a £60 million computer system has had to be scrapped after being described as “a shambolic failure.”
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If, therefore, NHS boards are to be reorganised, the review determining how this is to be done must be carried out by genuine experts, and not dictated by economic expediency or political convenience. The key test must be what works best in the interests of patients, wherever they may live.
This, then, may well be the test that the SNP administration has tended to avoid hitherto: a major shift in strategy which is likely to prove highly unpopular with local opinion, but which should, if properly thought through, offer an NHS which works — and which can be afforded.