A long hard look at NHS Scotland

scott arthurScott Arthur takes a hard look at the NHS in Scotland, the claims made about it and the evidence we have for how well it is being looked after.

 

The NHS saved my life.

This did not involve blue flashing lights or lots of drama. After a series of consultations, I was diagnosed with “sick sinus syndrome” and a few weeks later I had a state-of-the-art pacemaker fitted. All the staff I interacted with between when I last saw my GP to when I was discharged from Edinburgh Royal Infirmary were utterly professional and I have huge respect for them all.

However, it was very clear that the staff and systems in the NHS were stressed. The nurse who took me to theatre did so in her lunch break. I saw a doctor offer to take casework off an overloaded ECG specialist. On discharge I was asked to make an appointment with my GP practice to have my dressing changed within 72 hours. On calling, I found that no appointment was available for two weeks and that I had to rely on good will to be seen.  All this was in the space of a few hours.

These acts of good will typified my experience. Every member of NHS staff I met during my 24 hours in the ERI was absolutely dedicated to their job and willing to go the extra mile to help patients and colleagues, but it was clear that they were stretched. Indeed, two days after my operation I read the news that only around a quarter of nurses feel that their department is sufficiently staffed.

Based on this experience, I wanted to write about the NHS in Scotland and the challenges it faces.

Claim #1: The NHS is the best healthcare system in the world

Yes, it is certainly one of the best! The UK NHS has been declared the world’s best healthcare system by the Commonwealth Fund, a Washington-based foundation which is respected around the world, who rated its care superior to countries which spend far more on health.

Claim #2: The NHS in Scotland is better than the NHS in England

No! A comparative study in 2010 found that the NHS in England performed better than the devolved systems across the board. A similar independent study in 2014,  which included a wider range of performance measures, revealed that while there are few indicators on which a devolved country does better than England, the performance gap between England and Scotland has narrowed in recent years, but is still significant. One thing that stands out in this study is that deaths considered avoidable due to medical intervention are 20% higher in Scotland (see charts below – NE England is included as its demographics are closest to Scotland/Wales/Northern Ireland).

death

On the positive side, waiting times have fallen in Scotland to the extent that they are now comparable to England’s (see chart below as an example).

chart (2)

It is important to note that the English system performs better than Scotland’s despite our system having extra funding.

Claim #3: The Tories in Westminster are starving the NHS in Scotland of cash

nhs scotlandNope, the NHS is devolved and Holyrood decides what Scotland spends on the NHS. During the independence referendum campaign the SNP’s Yes Scotland warned Scots that “more private money and less public funding” from Westminster on the health service would “automatically trigger cuts for Scotland”.

What the SNP didn’t say was that the Tories were increasing NHS spending and the SNP was not passing it on. The impartial IFS found that the Tories had increased NHS spending by 4.4% and, although this would have resulted in extra Barnett money, the SNP cut funding in Scotland by 1.2% (see table below).

barnett

Looking at spending per capita also raises questions (see chart below). In England spending on health has increased in recent years, but in Scotland it has fallen by £51 per person.

chart

As recently as October 2015 Audit Scotland said that NHS funding in Scotland for day-to-day services and new hospital buildings had fallen by 0.7% in real terms over the last six years:

“Tightening budgets combined with rising costs, higher demand for services, increasingly demanding targets and standards, and growing staff vacancies mean the NHS will not be able to continue to provide services in the way it currently does. Together, these pressures signal that fundamental changes and new ways to deliver healthcare in Scotland are required now.”

Claim #4: The SNP have increased the number of nurses in NHS Scotland

Yes, but only after cutting them. When the SNP entered government, NHS Scotland had around 57,000 nurses and midwives (increased under the Labour/LibDem coalition from 53,000 in 2002 – a 7.5% rise). From 2008 to 2012, the SNP progressively cut the number of nurses to just over 56,000. It was not until 2013 that the number of nurses reached the level Labour had achieved. There are now ~59,000 nurses in Scotland – a 3.7% rise over 9 years (see chart below).

nurses

Claim #5: UK immigration policy is stopping Scotland recruiting the nurses it needs

Why does Scotland need to import nurses from outside the EU who have been trained at great expense to their own government?

The answer is simple – Nicola Sturgeon cut nurse training in Scotland when she was the Scottish Health Secretary. She cut the number of nurses entering training over three years from 3,400 to just 2,700 in 2012/13 (see chart below), claiming that her cuts reflected “emerging employment trends in NHS Scotland”. Indeed, when challenged by the RCN in 2012, Ms Sturgeon claimed her cuts were the “sensible way forward”.  At the time, the RCN was clear that the cuts would result in a real risk that there would “not be enough professionally qualified nurses graduating” between 2015-18.

Student Nurse

Events have shown that Ms Sturgeon should have listened to the RCN. In Scotland 75% of nurses think that wards are understaffed and 10% can’t take time away from their ward to undertake mandatory training. In January 2015 it was found that stress-related sick days among nurses in Scotland had risen by 34%. We have also seen that understaffing is at the heart of the failure of the A&E service to meet waiting time targets in Scotland.

Claim #6: The Scottish Government has a strategy to cut healthcare inequality

Yes, it has a strategy! This is how Audit Scotland described it in 2012:

“National strategies which aim to improve health and reduce health inequalities have so far shown limited evidence of impact”.

Audit Scotland said health inequalities were “long-standing and entrenched” throughout the country, and that “resources should be better targeted at those who require them most”. In response to the report the BMA urged the SNP Government to “use the unique relationship that GPs have with their patients and in their communities to target healthcare to those who need it most”.

In response to this damning criticism the SNP established a “taskforce”. Although this was welcome, it is clear that the most basic recommendation made by Audit Scotland has not been delivered 3 years later – healthcare resources are still not being  targeted where they are needed most.

In late 2015 Audit Scotland noted that GP practices in deprived areas had less funding than their colleagues providing healthcare to middle class Scots. The difference in funding equates to around 2000 fewer appointment slots per year in each practice serving deprived communities.

Claim #7: PFI/PPP was bad for the NHS and it is good that the SNP abandoned it

The SNP don’t like to admit it, but they are big fans of PFI. They know it is controversial, so they call it “Non-Profit Distribution” – don’t be fooled by the name, it is PFI.  In Edinburgh, the new Sick Kids Hospital and the Scottish National Blood Transfusion Service facility are being procured by the SNP using NPD/PFI. Indeed, just a few weeks ago John Swinney announced a new batch of projects which will be procured via NPD/PFI.

Claim #8: The SNP have stopped the backdoor privatisation of the NHS

This is bonkers. We know that about £82 million was spent by the SNP Government on private health firms last year, compared with £75.9 million the year before and £58m in 2006-7 when the SNP came to power. This increase comes after the First Minister Nicola Sturgeon’s pledge to save Scotland from the “creeping privatisation” of the NHS south of the border.

This does not include the involvement of the private sector in social care. One business which has benefited from this is Balhousie Care Group, Scotland’s largest private residential care home provider. The Chairman and founder is Tony Banks, a millionaire who is a key player in the independence movement.

Claim #9: A&E Waiting times are being reduced

Correct, but the waiting time target target is still being missed. At the beginning of 2015 is was clear that the SNP had lost control of A&E waiting times. After sustained pressure from Scottish Labour, the SNP started taking the issue seriously. Nonetheless, the most recent data shows that only 93.7% of patients were seen within 4 hours – the target is 95% (see chart below). In England the situation is marginally better with 93.3% (although there may be differences in how the data is collected/presented).

AandE

Personally, I find the obsession the Scottish establishment has with A&E waiting times unhelpful. It is a really important benchmark, but focussing solely on it is distracting. For example, is it not worse that so many children & young people that have had to wait more than 18 weeks to see a mental health specialist? The 18 week target is intolerably long and failing to hit it is unacceptable (see chart below).

mental.png

Claim #10: By tackling delayed discharge, there will be fewer cancelled operations

Correct, but the SNP are not delivering the progress they promised. Cancelled NHS Scotland operations were in the news recently – there were thousands of cancellations in 2015 (see chart below). Whilst this makes a change from reports of A&E waiting time targets being missed, the two issues are related. Both are linked to “delayed discharge” (AKA bed blocking).

Cancelled

Delayed discharge is where a patient is judged clinically ready to go home but continues to occupy a hospital bed while plans are made for appropriate follow-up care. These plans can be complex, but can also be as trivial as fitting a handrail on someone’s bath at home. At any one time hundreds of patients can be waiting weeks for discharge. This is bad for them and bad for the NHS.

To be fair to the SNP’s Health Secretary, Shona Robison, she said cutting the number of people stuck in hospital waiting for a care package to be arranged is an “absolute key priority” for the Scottish government. Indeed, she committed £100m to solving the problem (a few months earlier £5m was claimed to be enough). On the 25th of February in a BBC interview she said:

“I want over the course of this year to eradicate delayed discharge out of the system and I am absolutely determined to do that.”

Indeed, the seriousness of the issue led to Ms Robison invoking Nicola Sturgeon’s name a few weeks earlier:

“In presenting the Government’s programme for the year ahead, the First Minister made it clear that addressing delayed discharge is one of our key priorities and it is one to which I give my personal commitment.”

There we have it. With the support of Scotland’s First Minister and £100m in her pocket, Shona Robison gave a “personal commitment” to “eradicate delayed discharge” by the end of 2015. How did she do?

The situation up to October  was pretty poor (see chart below). The official assessment:

“In October 2015, there were 50,945 days spent in hospital associated with delays in discharge. This is a 6% increase from September and a 9% decrease on the same period last year.”

So whilst the SNP’s apologists may want to suggest that cancelled operations can be attributed to “acts of god”, alert readers will perhaps argue that the SNP could be doing more to deal with the delayed discharge of patients.

bed blockers

Claim #11: OK, there are problems in NHS Scotland but at least it is better than when Labour ran it

Labour have not been in power since 2007. Over that time there have been real improvements in medical science, clinical processes and treatments. If nothing else, we now have a much better understanding of how to eliminate hospital acquired infections. We must give the SNP credit for taking advantage of these innovations, but we must also be willing to accept that other parties would have done the same.

We also must accept that the reforms Labour enacted as part of the National Health Service Reform (Scotland) Act 2004 led to some short-term problems with service delivery, but ultimately had NHS Scotland on a much stronger footing by the time the SNP took office. Indeed, in 2014 the Nuffield Foundation had this to say about the impact of these reforms on waiting times:

“In terms of whether Scotland’s greater emphasis since 2005 on targets and performance management has had an impact, it appears that Scotland’s hospital waiting times now match England’s, suggesting, but not proving, a positive effect.”

Claim #12: Yes, but no matter how bad NHS Scotland is it’s better than Labour’s NHS Wales

Firstly, the Welsh Assembly does not have the same range of powers as Scotland’s Parliament. Secondly, the Barnett formula ensures Scotland has higher per capita funding than Wales. Nonetheless, it is often claimed by the SNP that NHS Wales is inferior to NHS Scotland. Why is this?

I can’t answer this fully, but others have considered it. The Nuffield Foundation say:

“Across a number of measures of performance, since 2006” NHS Wales “has improved to a similar level as England”, however, “common procedures in Wales indicate a lengthening of waiting times after a period of improvement, contrary to trends in England and Scotland.”

This is because the Welsh Government has made different spending decisions and has placed greater emphasis on prevention (the chart below shows the number of GPs), public health and social care. The shift of money from healthcare to social care has meant that delayed discharge and A&E overload have not been the issue they have been elsewhere in the UK.

chart (3)

It appears that in Wales longer waiting times are accepted as a price worth paying for better social care and preventative healthcare. Accepting that, we can’t simply focus on waiting times when comparing NHS Scotland with the Welsh system. To emphasise this point, the chart below shows satisfaction ratings.

chart (4)

Conclusion

NHS Scotland is not perfect, but it is not a shambles either. However, if it is to be there when we need it, we all have a duty to be honest with ourselves about how it is performing. This means that problems must be neither exaggerated nor swept under the carpet. Simply ignoring failures or boasting that what we have is very marginally better than NHS England/Wales is not good enough. We all have to think about what kind of NHS we want and what level of funding it deserves.

When judging the performance of the NHS, we can’t simply focus on a single KPI (e.g. A&E waiting times), but look at healthcare in a much more holistic way. We have to understand the link between GP provision, bed blocking, social care and the demands placed on A&E services.

Labour have been clear that their priority would be to take the pressure off the NHS by investing in social care. The Public Bodies (Joint Working) (Scotland) Act 2014 is clearly a mechanism for doing this as it will demand our Local Authorities work closer with the NHS to deliver social care. However, as both are underfundedthere is concern that service delivery will actually be harmed.  Nonetheless, there is huge potential to place much more emphasis on preventative healthcare in Scotland. A good start may be for the SNP Government to publish updated national social care standards and for all the parties in Scotland to bring forward proposals on how they can be delivered.

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62 thoughts on “A long hard look at NHS Scotland

  1. Selective ….

    you miss out large swathes of the report such as Waiting times for surgery where Scotland has at least as good as England and in most cases a better performance than any other part of the UK.

    More Doctors per head of population….

    More Nurses per head of population

    Your 2010 study link shows Scotland performing better than any other area in the UK (apar from London in only 1 case in Staffing and Funding per head, your graph on this shows Clearly that Scotland not only has spent significantly more per head than any other part of the UK

    Your graph confirms this to be the case and also shows that the Tories ( I love it when Labour defends the Tories performance) Increased NHS Spending to improve the spend per head…..they came nowhere near the Scottish level that we had sustained for 7 years……

    and II hate to point out the Logic but if the UK SPends more….but less per head than Scotland….any rise that is passed on from Barnett can be integrated into Scotland’s higher spend per head( extra money we spent form other areas of the budget to boost NHS Scotland ) can now be reallocated….and still spend more per head..

    Hospital Cancellations for non clinical reasons is a tiny 1.55%…by far the biggest issue in cancellations is the patients themselves cancelling the op…which is beyond the NHS control

    Now your graph of GPs per head count graph comes from some other article….clicking on your 2014 link gives a graph that shows Scotland vasty better than rUK and by some margin (0.95 compared to 0.8 NHS England)….is this an error on your part?

    the last part is the best…..the SNP has been working towards integrating Social Care and Helath for many years…….Labour appear to be last on the bandwagon again

  2. Hi Galbraith.
    the Nuffield Foundation report is a small part of the blog, but I did try to give a balanced overview of what it found. The bottom line is, despite the many great things NHS Scotland is doing, NHS England performs better.

    As for cancellations, my plot outlines how many operations were cancelled by patients

    This is worth a read:
    http://www.deadlinenews.co.uk/2016/01/10/nhs-lothian-accused-of-manipulating-waiting-list-times/

    1. Balanced? If you were going to present a balanced anything why did you do it in an unbalanced politically bias forum?

      Do you expect people who read your garbage to actually believe your intent is to provide balance?

      I could take the time and effort to go over it all in detail and point out the glaring deliberate misconceptions the glaring deliberate misrepresentations the glaring deliberate out of context comparisons not to mention the glaring deliberate failure to actually provide balance in showing the numerous improvements in services across the board in relative terms to anybody anywhere.

      But most of all the unbalanced way in which you failed to compare how much of the NHS has been privatised in England and Wales relative to Scotland and how much of a continued PFI PPP burden is imposed South of the border.

      But then you’ve never allowed reality or honesty or balance to interfere in your pro active support for all that is corrupt and worthless in the UK.

      1. Hi Mike,
        The bottom line is, despite the many great things NHS Scotland is doing, the Nuffield Foundation say NHS England performs better. If you know better than them, can you speak to them directly?

        Scott

        1. “Hi Mike,
          The bottom line is, despite the many great things NHS Scotland is doing, the Nuffield Foundation say NHS England performs better. If you know better than them, can you speak to them directly?”

          But clearly they aint you are. You’ve chosen to dishonestly misinterpret a report misinterpret the data within it and stated a conclusion the report never made and wouldn’t have even if the data actually showed it to be the case which it clearly doesn’t.

          And you actually called that being balanced.

          The more disingenuous amongst us would actually call that unbalanced.

          Not to mention the fact that the trustees of the Nuffield foundation are a whos whos of the members of the House of Lords and are clearly not balanced when it comes to making politically sensitive reports.

          There is that hint of Red Tory again.

    2. “but I did try to give a balanced overview of what it found.”

      When four out of the six comparative graphs and tables show Scotland performing worse, one graph is wrong and only one showing Scotland performing better – Despite the fact there are numerous examples of Scotland being on top in many areas from the documents you cite….
      you have an odd definition of balance.

      “The bottom line is, despite the many great things NHS Scotland is doing, NHS England performs better.

      again, in spite of the numerous examples from your sources that show Scotland outperforming other areas of the UK, that you chose to ignore, you still try to claim this as true.

      “As for cancellations, my plot outlines how many operations were cancelled by patients”

      but the narrative and implication of this section sets out delayed discharge as the main culprit – despite it being only a fraction of the 1.55% of calculations for non clinical reasons. The cancellation rate for clinical, patient and other reasons is at least 5 times higher….

      This is worth a read:

      I assume you’re being ironic when you stated…..

      “Personally, I find the obsession the Scottish establishment has with A&E waiting times unhelpful. It is a really important benchmark, but focussing solely on it is distracting.

      then proceed to focus on it……
      then give me a additional reference about it……
      all in the backdrop of a Labour party that screamed for the figures to be released on a weekly basis……
      Then would bleat loudly about how bad they were to anyone who would give them airtime in the run-up to the General Election ….

      1. Read the Nuffield Foundation report. It accepts that NHS Scotland is doing well in many areas. However, it concludes that overall NHS England is doing better.

        1. Have done….here are a few excerpts

          The previous comparative study of the four UK health systems, published in
          2010 and revised in 2011, found that the NHS in England performed better than
          the devolved countries across a range of indicators. However, this latest study,
          which includes a wider range of performance measures, reveals that while there
          are few indicators on which a devolved country does better than England or its
          North East region, the performance gap between England and the rest of the
          UK has narrowed in recent years. There is little sign that one country is moving
          ahead of the others consistently across the available indicators of performance.

          Whatever gap there was has narrowed an we exceed in some areas

          England performs marginally better across a number of key indicators,
          including amenable mortality rates, life expectancy and ambulance response
          times

          Marginally better and in the areas such as life expectancy which relate mainly to lifestyle not NHS performance.

          Overall, this research suggests that despite hotly contested policy differences
          between the UK health systems since devolution on structure, competition,
          patient choice and the use of non-NHS providers, there is no evidence linking
          these policy differences to a matching divergence of performance

          in fact the SNP have closed the gap due to hard work, a gap that Labour were happy to preside over with a worse record

          In terms of whether Scotland’s greater emphasis since 2005 on targets and performance management (for example, inrelation to hospital waiting times) has had an impact, it appears that Scotland’s hospital waiting times now match England’s, suggesting, but not proving, a positive effect

          in short what we’re doing is working

          Given the limited comparable data on performance across the four countries over
          time before and after devolution in this and previous reports, it is not possible to
          give definitive assessments of performance across the UK on all the measures
          that one might want

          in summary, England’s performance is at best marginally better (based on incomplete data) and Scotland has closed the gap in all areas and exceeded England in some……The trend has been this way for almost a decade now ( how long has the SNP been in power ? – oh yeah – about 9 years)

          I know in whose hands I will place my trust the NHS will be looked after

  3. As far as I can see today, there are no scandalous PFI schemes on a par with the Edinburgh Royal Infirmary, Hairmyres, Skye Bridge or any of the other money pits the Tory and Labour governments threw our tax cash. It cost us a fortune, and still does.
    Perhaps the good Doc knows of some SNP fiscal health disasters just as bad?. No ?
    As for more money being spent in England, how much of that is diverted to private profit through the various privatization schemes Labour and the Tories have instigated south of the border. And the endless re-organisations. How will the proposed USA/EU trade deal impact on health outcomes?
    Health Stats between Scotland and England?
    Scotland has had to come from a very bad place, in terms of health—–after Labour had electoral hegemony in Scotland since 1959.
    Perhaps the good Doc could discuss THAT.

    1. That’s exactly the point Gavin. Dishonest Labour acolytes such as Scott and Duncan will happily promote the idea that the English NHS is receiving greater proportional funding by adding the PFI PPP obligations onto the overall NHS budget for England and Wales even though the NHS wont see a penny of it as it goes directly to the Private firms the debt is due to.

      It is billions not directly attributable to the NHS at all and is certainly not actual funding they can use or spend.

      Yet they wont attribute the PFI PPP debt attributable to the Scottish NHS as part of the overall Scottish funding deliberately so they can present dishonest comparisons.

      But never let it be said Labour leaves any stones unturned when it comes to spinning misinforming or outright bare face lying in support of their beloved disunion even when it means getting comfortably in bed with their Blue Tory English votes for English laws comrades.

      1. The only problem with this brilliant debunking is it is not true. The comparison is made on a like-for-like basis.

        1. Oh but it is true. The English NHS funding figure is taken as the gross allocated figure inclusive of its PFI PPP obligations whereas the Scottish funding figure used by Labour and the other opposition in Scotland is taken from the Barnett proportional consequential calculations which doesn’t include any PFI PPP obligation figures at all.

          You don’t pass PFI PPP obligations through the Barnett process.

          1. That is unadulterated garbage. NHS Scotland spending figures come from the Scottish Government, not the Barnett formula.

        2. Duncan thinks our PFI PPP obligations are a direct population proportion of the English PFI PPP obligations and are not separate debt figures calculated on specific spending obligations.

          Or at least his obsessive agenda driven dishonesty wants us to believe that.

          Must be special having to daily make up justifications for pretending belief in things you obviously don’t believe in and cant support by being honest.

        3. “That is unadulterated garbage. NHS Scotland spending figures come from the Scottish Government, not the Barnett formula.”

          Is this another one of your deliberate trolls? Scotlands public spending budget is determined by the Barnett formula calculations based on a population proportional public spending budget allocated to England.

          Scotlands Barnett funding amounts to around 24 billion. The Scottish Government commits around half of this budget to the NHS it then has to find a further 1/2 billion to pay off its annual PFI PPP commitments forced on us by the previous Labour administration and their corrupt Tory practice of passing over public funding to the private sector.

          The PFI PPP obligations for Scotland are not population proportional debt allocations but debt accumulated by direct spending in Scotland by the last Labour administration.

          1. You claimed the Scottish NHS spending figures came from the Barnett formula. You lied. Scottish NHS spending figures come from the Scottish Government. You may be convincing yourself and your buddies here but you’re not convincing anyone rational.

            The comparisons made here, quoted from independent sources, compare like with like. Your desperation to see the SNP as better than anyone else leads you to make dishonest statements. stop it please. Look at the independent data.

      1. This is my reply to Doc Scott as I cannot directly answer HIS comment.
        No, I do not think Labour PFI—bad…………SNP PFI–good. I am not a member of any political Party, though was once a Labour member. My interest is the “public good”, an old fashioned notion I know.
        However, I had asked you, previously, a question; if you could point out any PFI deal instigated by the SNP which carried the same debt profile as the historic Labour/Tory schemes had previously carried.
        Or if any PFI scheme of the SNP had left the ownership of the publicly paid for investment, OUT of public ownership, as happened under Labour/Tory schemes.

        If you cannot give a serious critique on cost, ownership, transparency etc showing the same flaws in SNP schemes as in previous Labour/Tory schemes( heavily criticized by all opinion, on economic and political grounds ) then I think you have answered your own question.

        1. If your point is that SNP PFI is somehow better, why not show us your analysis rather than asking me to do it for you?! The peer reviewed analysis I provided a link to speaks for itself. Ignore it if you want.

          1. Sorry Doc, but your cut and paste exorcise provided no such link on the merits of historic or new PFI schemes.
            It’s YOUR assertion that there is no difference between Labour/Tory PFI and the not-for-profit SNP funding scheme, then it should be up to you to justify that assertion.
            As there are no outraged economists/politicians on-line, in the press or on BBC Scotland complaining about the outrageous profits made, or that we won’t ever own the investment we have paid for—–then I think my case is made–even by default.

      2. Your point appears to be:
        Labour PFI = Bad
        SNP PFI = Good.

        Repeating the same bare faced lies over and over is why your MSPs are fighting like ferrets in a sack for list seats knowing they wont get any constituencies.

        The SNP are not using PFI for anything other than paying off Labours debt obligations Labour ideologically created during their abysmal time in office.

  4. We must give the SNP credit for taking advantage of these innovations, but we must also be willing to accept that other parties would have done the same.

    Grand oracle and soothsayer of Scotland how did you come to the conclusion above did you have a deek at the old chrystal ball, the article is the usual dire diatribe of drivel SNP bad bad bad maybe you should change the record.

  5. SNPbad.

    If we all tell ten to tell ten to repeat SNPbad ten times a day it might work.

    1. Thanks for alerting me to the use of the number ten it just inspired me to modify the nursery rhyme of ten green bottles sitting on a wall instead to ten Red Tories sitting on a wall the kids love it and are laughing their heads off once again thanks.

  6. Who owns the new “same as PFI” Sick Kids Hospital – NHS Lothian or a bunch of venture capitalists? Just wondering.

    The last time the question of PFI came up I pointed out that the PFI-procured school I work in belongs to a private finance company, whereas the newer PPP-acquired schools belong to the local authority.

    The discussion appeared to stall at that point.

      1. You’re offering a peer created peer reviewed documents as contradictory evidence to your claims while continuing to deny you’re a Red Tory.

        Do you think you have an ounce of credibility left online Scott?

        1. “Peer created Peer”—nice one, its almost biblical.

          But we all know Scottish Labour likes their Peers—-there are dozens of them.

          Some pundits have commented on the number of Lib Dem Peers compared to their elected MP’s but I have heard no mention of Scottish Labours vast discrepancy in this regard.—-Now that we have a “Scottish Labour” Party, allegedly.

      2. Anecdote? I asked a question. Here it is again:

        “Who owns the new “same as PFI” Sick Kids Hospital – NHS Lothian or a bunch of venture capitalists? Just wondering.”

        If you don’t know that answer, that’s fine. It would be better to say so than waffle though. I’m asking because I don’t know and I’m interested in the answer.

        The PFI procured Falkirk schools belong to a company called Class 98, who are in turn a subsidiary of Semperian PPP Investment Partners Group Ltd. None of this is a state secret It’s all in the public domain and was much commented on in the press then and since. The 25 year lease on the schools will cost Falkirk Council around £370 million, at which point they will have the option of buying the buildings from Semperian or whoever owns the assets at that time.

        If the model currently in use to finance projects like the new Sick Kids provides better terms for the public body commissioning the build, in this case presumably NHS Lothian, then I would say it was different to the one used in Falkirk. Your mileage may vary.

        I suppose my account of the state of the Falkirk PFI buildings is anecdotal, but it’s an informed opinion based on the fact that I’ve worked in one and visited the others over the last 14 years. Once again, your mileage may vary.

  7. Wow what an article, imagine all the time it took to search out all those figures and graph’s and set up the article just so.

    And after all that it is completely debunked within a few comments, even an intervention by Duncky H barely lasts a couple of comments more. For me it was the cancelled operations, this was attempted to be smeared just a couple of weeks back, until it was pointed that 98% + of planned operations went ahead in Scotland.

    As for PFI funding, that’s a noose round labours neck for the rest of time.

    1. Davy,
      You are confusing people throwing mud with a debunk. At the core of my blog is an authoritative report by the Nuffield Foundation. Your debunkers can’t even accept it’s conclusion… but offer no alternative analysis.

      As for planned operations, I quote Scottish Government data.

  8. “You claimed the Scottish NHS spending figures came from the Barnett formula. You lied.”

    The NHS spending figure cannot be greater than the sum that Scotland receives via the Barnett arrangement therefore the Barnett spending allocation determines the maximum any Scottish Government can spend on not only the NHS but its entire spending program across Scotland.

    So clearly even if I had actually claimed that it wouldn’t be a lie at all.

    One of the many many lies Labour are promoting is to claim that the Scottish Government is underfunding the NHS by trying to claim it funds less in proportion to NHS England. You’re doing this by attributing NHS Englands PFI PPP debt to their overall budget allocation while the figure you attribute to NHS Scotland is the proportion of the Barnett allocation the Scottish Government spends on the NHS which is approx. Half of the entire Scottish Barnett spending budget.

    Labours idea of giving NHS Scotland more funding is to commit a greater proportion of NHS spending to PFI PPP Private finance which amounts to taking away NHS public funding and giving it over to Private corporations thereby ensuring the erosion of the NHS as a Public service altogether and a greater personal cost to the taxpayer as they will not see any reduction in their overall taxation burden but will be presented with an additional private cost for health.

    That old Red Tory philosophy again. And you wonder why you’re in the political toilet bowl waiting for that level to be pulled.

    1. You’re still spouting the same garbage and it remains garbage. The figures are compared on a like-for-like basis. Barnett has sod all to do with it. The Scottish Government’s NHS spending is not defined by Barnett.

      1. The Scottish Governments entire public spending budget is determined by Barnett. It cant allocate anymore funding than it gets via Barnett to anything.

        Ive explained clearly and accurately how Labour is comparing the NHS allocation of funding between Scotland and England. You wont do anything other than deny it because Labour are deliberately running a campaign of bare faced lying scaremongering and over all SNP BAD bullshit because they have no way of running with a Labour good campaign.

        I get that. Its about time you get the fact that nobody but the red rosette voting drone the in party corrupted and the Union Jack wearing fanatic wants Labour in power in Scotland as a result.

      2. How much of NHS England’s budget is removed by profit/debt repayment, and how does that compare with Scotland?
        That stat might give us a clearer view of the performance of two Health services.
        While Scotland is still paying off the acrued debts from the Labour/Lib Dem era, in England it is working exactly as Labour/Tory regimes have planned over the last two decades with a substantial private element as normal.

          1. Doc, I know what a peer review means. What your “peer review” does not cover, is your assertions on PFI.
            Nor do I need any research for my comments—–I know they stack up.
            These is no comparison with what happens now, compared with the Labour/Tory PONZI rip-off PFI schemes of the past, that gave investors vast disgraceful profits, and left publicly funded investments in PRIVATE hands for decades—-sometimes for ever.

            If you had a rebuttle, you would be crowing about it. You haven’t!

  9. This article seeks to blind people with a blizzard graphs and so called “facts”. That is its major problem. People will look at it, feel their eyes glaze over and move on with ironic “aye, right” thoughts in their head before they’re half way through. A pro SNP blogger who wants to put in the time could put an equally graph ridden, “fact” bloated article to the masses in defence of the SNP record and eyes would similarly glaze over.

    Labour’s real problem is the image people have of their party. Articles like the one above will not change that. People know the SNP has governed through a recession, an austerity driven UK government and subsequent cuts in the amount of money they can spend. People are not stupid no matter how much Labour would wish them to be. Many have made the rational choice to back the party they think can govern Scotland better than the others and that party is the SNP. According to its own report, commissioned by Labour interim leader Harriet Harman, the Scottish Labour party is viewed as incompetent and irrelevant by those voters it most needs to win over. Add to that an arrogance that flies in the face of that “incompetent” and “irrelevant” voter perception (and that is ably evidenced by the above article) and it hard to see any way back for the Scottish Labour Party as it is currently constituted.

    Ironically, given their double act in the Better Together campaign, both the Labour and Tory partys in Scotland will likely only see a revival in an independent Scotland where the SNP and the constitutional question are sidelined. As separate partys (controlled from London) under the union, they will slip ever further from relevance.

    1. If your imaginary “pro SNP blogger” friend can come up with an independent and authoritative study to back his/her argument, like that I cite from the Nuffield Foundation to back mine, I’d be very interested.

      1. Only a Tory would refer to a Tory report designed specifically to be ideologically politically tainted as an authoritative study and only a dishonest agenda driven online troll would try to pretend the data within it provided verification for his unmatched conclusions.

        I’m not detecting any effort at all in trying to be credible which brings me to the conclusion that all your online efforts are nothing but deliberate wind ups and shit stirs.

        If you’re going to put up misinforming data then at least have the nonce to make your conclusions fit the rhetoric.

        1. “I’m not detecting any effort at all in trying to be credible”

          From you, Mike, that’s quite a statement. 🙂

          1. Grand oracle and soothsayer of Scotland you have been rumbled have a butchers at the link below and see the acolytes of the Scottish Labour section Red Tories, scrutiny of your source has shown it has come from a biased organisation fronted with its board members linked to big business, although I am not surprised by that as you are in compitition with your namesake the Tories to court and bow to big business so don’t be surprised if the good folks of Scotland at the Scottish elections are going to vote for 1st SNP 2nd Tories 3rd Scottish Labour section Red Tories and probable extinction.

            http://www.nuffieldfoundation.org/finance-and-investment

          2. The board and trustees are tories Scott which of course you know. There is that trolling / shit stirring / wind up factor again.

            You clearly have no way of even trying to come up with anything worthwhile or relevant.

          3. That is quite simply a lie. You consistently make things up. What makes you do that?

          4. I’ve no idea of their political affiliations , however, the fact they are Tories and “biased” would not bar them from being a charity. Public Schools are charities (disgracefully) but that does not take away from the fact they are overwhelmingly Tory in outlook and biased in favour of private education.

          5. “I’ve no idea of their political affiliations”

            “the fact they are Tories”

            Oh just take a look at yourselves.

          6. I think you are seeing what you want to see Mr Hothersall.

            I was not claiming the Nuffield Trust WERE Tories, I was merely pointing out that IF they were Tories, and biased, it would not bar them from being a charity.

          7. Then you need to write better. This comment stream is littered with assertions that they are Tories, including yours.

          8. Grand oracle and soothsayer of Scotland Professor Rhind CBE FRS Hon FBA is on the basis of being a Dirctor for the Bank of England a Tory see evidence in link below

            https://en.m.wikipedia.org/wiki/David_William_Rhind

            As for Dame Colette Bowe DBE a definite Tory In 1986 she was caught up in the Westland affair when, as Chief Information Officer to the Department for Trade and Industry, she was ordered to leak to the Press Association a letter written by the Solicitor-General which supported the government’s stance and opposed that of Michael Heseltine; she refused to disclose exactly who had given the order see the evidence in the link below

            https://en.m.wikipedia.org/wiki/Colette_Bowe

  10. It should be noted that I have repeatedly asked Doctor Arthur to back up his assertions that the PFI schemes entered into by the Labour/Tory regimes of the past were in no way different from the not-for-profit scheme used now by the SNP. Not least in terms of profit and ownership.
    At no point has he attempted to justify his claim, preferring to point in the direction of research, not relevant to the question, and dismissive asides.
    Poor show, Doc.

      1. Grand oracle and soothsayer of Scotland when is a Tory not Tory its when you are Dame Colette Bowe DBE who was working for the Tory government in 1986 so she is a Tory. I am not out of my depth I am sailing on the good ship Ecosse towards an Independent Scotland there is a fair wind behind the sails and the ship is making good headway towards Scottish Independence and it feels so good.

        1. Colette Bowe also worked for the subsequent Labour Government. Does that make her Labour?

          1. El Capitano the answer to the question is while working for the Tory Government she was a Blue Tory when she worked for the Labour Government she was a Red Tory so whichever way you look at it she is a Tory.

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