Humza Yousaf rejects call for probe into NHS chief ‘two-tier’ meeting



HUMZA Yousaf has rejected Tory pleas for an Audit Scotland probe into a the meeting of NHS directors where they discussed the possibility of a ‘two-tier’ health service. 

Answering questions in Holyrood, the Health Secretary said it was a “genuinely laughable” suggestion. 

The SNP minister insisted reform of the health service in Scotland is necessary but he told MSPs that the NHS would remain “a universal service, free at the point of use, publicly funded and publicly delivered for all.”

The Health Secretary was being probed in parliament after the BBC obtained confidential minutes from a top level meeting of NHS chiefs warning of a “billion pound hole” in their budget.

According to the report, executives at the September 21 meeting raised the possibility of curtailing some free prescriptions and a “pause” in funding for some new drugs unless they can be proved to save the NHS money.

The leaked minutes also point to an alleged “disconnect” between the pressure felt by health boards and “the message from SG [Scottish government] that everything is still a priority and to be done within budget”, adding: “Concern was noted that there may be siloed discussions ongoing within Scottish government that do not include CMO/CNO (Chief Medical/Nursing Officer).”

Executives are said to have expressed a view that “fundamental reform” of the primary care model “must be on the table”, and that the success of the NHS has been built on a model “that no longer works today”.

The directors noted that some members of the public “are already making the choice to pay privately” while the NHS is “picking up the cost for life-enhancing not life-saving treatments”.

This reportedly led to a suggestion to “design in a two-tier system where the people who can afford to go private”.

Answering a topical question in Holyrood, Mr Yousaf downplayed the significance of the meeting. 

He told MSPs: “It was an informal meeting of a small number of NHS directors, not a meeting of NHS chief executives, the draft note of the discussion does not represent the view of NHS chief executives. 

“The founding principle of our National Health Service as a universal service, free at the point of use, publicly funded and publicly delivered for all, is not up for debate nor indeed discussion.

“From abolishing prescription charges to removing dental charges for young people. This Government has a laudable track record in dismantling any financial barriers that continue to exist in a national health service.

“Let me repeat, while reform undoubtedly is necessary in the face of a global pandemic, that reform will never ever be in contradiction of the founding principles of our NHS.”

Labour’s Alex Rowley said a two-tier system was already happening. 

“If you need an operation, a knee or a hip operation and you can afford that, then you will get it. If you have savings and you can pay for you will get an operation. And if you are able to borrow the money to pay for that, then you will get an operation. 

“But for those who can do none of these, they suffer in pain on long waiting lists. I reiterate we are already falling into a two-tier health system. 

“I have to ask, does the Cabinet Secretary understand the enormity of the situation of the crisis our NHS here in Scotland is in? We have had the Covid recovery plan, our winter plan, our workforce plan, a delayed discharge plan, and despite all of these things are getting worse. 

“No wonder NHS chiefs are thinking in this way because these plans are not working.”

Mr Yousaf said it would be wrong to “underestimate the impact, not just of the global pandemic, but, of course, Brexit and the impact that has on our social care workforce, something I know he recognizes, and of course the impact of high inflation costs and energy costs on our health service. 

“Any one of these factors was enough to cause significant challenges in our health and social care systems. The fact that we’ve been hit by all three, not just in quick succession, in fact, some of them concurrently, is causing huge impacts on our health service not just here in Scotland, but right across the UK.”

Mr Yousaf said social care was at the “heart of this” and that improving capacity would improve A&E performance times and waiting times for elective care.

The Tory health spokesperson, Dr Sandesh Gulhane raised the concerns around the “lack of clinical input into political decision making, a disconnect between messaging from the Scottish Government and the reality that the boards are facing, and siloed discussions within the Scottish Government. 

He urged the minister to “ask Audit Scotland to investigate the controversy and details surrounding this meeting?”

Mr Yousaf said it was “genuinely laughable” to think that was a good use of Audit Scotland’s time. 

He added: “As I’ve said, it does not represent the view, neither of NHS chief executives nor NHS chairs, nor the chief executive of the NHS, nor the chief operating officer and may I say most importantly, by anybody in government, because we are the ones of course, that decide the policy of the National Health Service. 

“No, I won’t ask Audit Scotland. He can ask Audit Scotland if they think that is a good use of their time.” 

Mr Yousaf said the SNP “should be judged on our deeds” when it comes to the health service.





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Huma Yousaf rejects call for probe into NHS chief ‘two-tier’ meeting



HUMZA Yousaf has rejected Tory pleas for an Audit Scotland probe into a the meeting of NHS directors where they discussed the possibility of a ‘two-tier’ health service. 

Answering questions in Holyrood, the Health Secretary said it was a “genuinely laughable” suggestion. 

The SNP minister insisted reform of the health service in Scotland is necessary but he told MSPs that the NHS would remain “a universal service, free at the point of use, publicly funded and publicly delivered for all.”

The Health Secretary was being probed in parliament after the BBC obtained confidential minutes from a top level meeting of NHS chiefs warning of a “billion pound hole” in their budget.

According to the report, executives at the September 21 meeting raised the possibility of curtailing some free prescriptions and a “pause” in funding for some new drugs unless they can be proved to save the NHS money.

The leaked minutes also point to an alleged “disconnect” between the pressure felt by health boards and “the message from SG [Scottish government] that everything is still a priority and to be done within budget”, adding: “Concern was noted that there may be siloed discussions ongoing within Scottish government that do not include CMO/CNO (Chief Medical/Nursing Officer).”

Executives are said to have expressed a view that “fundamental reform” of the primary care model “must be on the table”, and that the success of the NHS has been built on a model “that no longer works today”.

The directors noted that some members of the public “are already making the choice to pay privately” while the NHS is “picking up the cost for life-enhancing not life-saving treatments”.

This reportedly led to a suggestion to “design in a two-tier system where the people who can afford to go private”.

Answering a topical question in Holyrood, Mr Yousaf downplayed the significance of the meeting. 

He told MSPs: “It was an informal meeting of a small number of NHS directors, not a meeting of NHS chief executives, the draft note of the discussion does not represent the view of NHS chief executives. 

“The founding principle of our National Health Service as a universal service, free at the point of use, publicly funded and publicly delivered for all, is not up for debate nor indeed discussion.

“From abolishing prescription charges to removing dental charges for young people. This Government has a laudable track record in dismantling any financial barriers that continue to exist in a national health service.

“Let me repeat, while reform undoubtedly is necessary in the face of a global pandemic, that reform will never ever be in contradiction of the founding principles of our NHS.”

Labour’s Alex Rowley said a two-tier system was already happening. 

“If you need an operation, a knee or a hip operation and you can afford that, then you will get it. If you have savings and you can pay for you will get an operation. And if you are able to borrow the money to pay for that, then you will get an operation. 

“But for those who can do none of these, they suffer in pain on long waiting lists. I reiterate we are already falling into a two-tier health system. 

“I have to ask, does the Cabinet Secretary understand the enormity of the situation of the crisis our NHS here in Scotland is in? We have had the Covid recovery plan, our winter plan, our workforce plan, a delayed discharge plan, and despite all of these things are getting worse. 

“No wonder NHS chiefs are thinking in this way because these plans are not working.”

Mr Yousaf said it would be wrong to “underestimate the impact, not just of the global pandemic, but, of course, Brexit and the impact that has on our social care workforce, something I know he recognizes, and of course the impact of high inflation costs and energy costs on our health service. 

“Any one of these factors was enough to cause significant challenges in our health and social care systems. The fact that we’ve been hit by all three, not just in quick succession, in fact, some of them concurrently, is causing huge impacts on our health service not just here in Scotland, but right across the UK.”

Mr Yousaf said social care was at the “heart of this” and that improving capacity would improve A&E performance times and waiting times for elective care.

The Tory health spokesperson, Dr Sandesh Gulhane raised the concerns around the “lack of clinical input into political decision making, a disconnect between messaging from the Scottish Government and the reality that the boards are facing, and siloed discussions within the Scottish Government. 

He urged the minister to “ask Audit Scotland to investigate the controversy and details surrounding this meeting?”

Mr Yousaf said it was “genuinely laughable” to think that was a good use of Audit Scotland’s time. 

He added: “As I’ve said, it does not represent the view, neither of NHS chief executives nor NHS chairs, nor the chief executive of the NHS, nor the chief operating officer and may I say most importantly, by anybody in government, because we are the ones of course, that decide the policy of the National Health Service. 

“No, I won’t ask Audit Scotland. He can ask Audit Scotland if they think that is a good use of their time.” 

Mr Yousaf said the SNP “should be judged on our deeds” when it comes to the health service.





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NHS: pay more, do less, or change the funding model



THE Scottish Government has said it expects the NHS to take five years to “recover” from the pandemic. But some clinicians fear the health service in its current form is in terminal decline – and will not survive.

A two-tier system is already gaining ground as increasing numbers of patients who can afford to turn to the private sector for hip and knee replacements, rather than face waiting years on the NHS.

In dentistry, most practices are refusing to take on new NHS patients, while dentists warn that they can no longer afford to provide more than “basic care” on the NHS amid spiralling overheads.

READ MORE: ‘No plans’ to charge wealthier patients for NHS care despite row over leaked minutes 

Previously routine care has faced cutbacks: in some cases patients who would have been seen every four weeks by an NHS podiatrist pre-Covid are now seen only when ulcers or wounds have resulted in infection. Some opt to pay privately instead; those who cannot end up at increased risk of avoidable harm and hospital admissions.

Leaked minutes from a meeting of health board executives refer to a “disconnect” between politicians too terrified to rock the boat, and senior clinicians who know that things cannot go on as they are.

When the NHS was established, average life expectancy was 66 for men and 70 for women. It was not designed for people living for decades, into their 80s, 90s or beyond, with multiple chronic illnesses.

READ MORE: Health inequalities widening between children in Scotland 

The past 12 years has pushed the NHS to breaking point as austerity squeezed resources, and the pandemic has seen waiting lists for elective care balloon.

At the same time, hospital bed numbers have been cut without a corresponding investment in social care.

The number of care home places has shrunk, and home care providers report “impossible” recruitment difficulties which leave elderly patients stranded and deteriorating in hospital.

An ageing population means we can never fix the NHS unless we fix social care, but beyond that the NHS still faces tough questions.

There is a sense that the NHS debate is so toxic that no Government – at Westminster or Holyrood – wants to do anything other than tinker round the edges, which will only seal its doom.

READ MORE: Is there any point to NHS waiting times targets if they haven’t been met in years?

We either have to increase investment; do less; or change how we fund it.

The Scottish Government’s hands are tied to some extent by tax and spending decisions taken at UK level, but even if Scotland were independent the SNP insists it would stick by the NHS model.

Yet many of our neighbours such as Ireland, with insurance models that continue to provide a free safety net for the poorest, spend the same or less on healthcare as a percentage of GDP but boast more beds, staffing, and equipment per head – and growing life expectancy.

Surely an open debate is better than privatisation by stealth?





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The destruction of Scotland’s NHS will spell defeat for the SNP



LIKE all good fairytales, there are myriad versions of The Goose That Laid the Golden Egg. However, every telling compromises the same basic elements and ends with the same stinging moral.

A stupid farmer finds himself the lucky owner of a goose that lays one gleaming golden egg each morning. The creature makes him wealthy and brings health and happiness to his family. Rather than live contentedly, though, the farmer demands the goose lay two eggs each day. The creature can’t, so the farmer chops off its head with an axe. The stupid farmer and his family end up penniless beggars.

And the moral of the story is: be thankful for what you have, nurture it and don’t let greed and stupidity be your undoing.

We can only hope that Nicola Sturgeon, Humza Yousaf and John Swinney have at least a passing knowledge of Aesop’s fables. For right now, they appear to be a family of rather stupid farmers about to kill our society’s equivalent of the golden goose: the National Health Service.

Yesterday it emerged that NHS leaders in Scotland are discussing a complete abandonment of the founding principles of the health service. That’s how bad matters have gotten under the custodianship of the SNP Government.

In September, NHS Scotland health board chief executives discussed the creation of a “two-tier” system, with the wealthy paying for treatment. They also mulled over the end of some free prescriptions, sending patients home more quickly from hospital – which clearly involves higher risk – and pausing funding for some new drugs.

The meeting included an update from NHS Scotland chief executive Caroline Lamb. Executives were given a “green light to present what boards feel reform may look like”, and told “areas which were previously not viable options are now possibilities”.

A “billion-pound hole” exists in the budget. It’s “not possible to continue to run the range of programmes” on offer while “doing no harm”. Executives warned: “Unscheduled care is going to fall over in the near term before planned care falls over.” The Scottish Government is “divorced from [the] reality of life and purpose of service”, and there’s “disconnect from the pressure that the boards are feeling and the message from SG [Scottish Government] that everything is still a priority and to be done within budget”.

“Fundamental reform”, we’re told, “must be on the table”. The current model “no longer works”.

Nobody needs a rehearsal of the state of the NHS today – of waiting lists, ambulance times, A&E performance, GP and consultant appointments. People are dying unnecessarily because our health service is collapsing: that’s the real measure of our Government’s deadly failure.

Over recent months, I’ve spoken to a series of well-known doctors about the state of the NHS, and they were all clear that its collapse is the responsibility of politicians – and voters who elect them. There’s no real difference in the disastrous political mismanagement north or south of the Border. Regarding the NHS, the SNP is pretty much just as bad as the Tories – to say otherwise is sheer partisan nonsense, which simply puts the interests of a political party ahead of public health.

Arguably, though, Scotland is in a worse state than England, because the Tories don’t have the shield that the SNP does to protect them from much-needed criticism. First, the SNP endlessly abnegates responsibility by blaming everything on London. It’s true that London is the ultimate holder of the purse strings, but power means responsibility and the SNP has been in government for nearly a generation. If the SNP can’t take responsibility for the NHS what the hell is the point of it being in power?

Secondly, the SNP’s base – the hardline nationalist contingent – would quite literally let the party away with murder. The belief is that any wound to the SNP is a wound to independence, and therefore no criticism of the Sturgeon administration can be broached.

If the NHS is a benchmark, then the SNP is unfit for government. It’s becoming hard not to see the SNP as, in essence, an umbrella campaign group that simply wants independence, rather than a party dedicated to making the powers it has work as best they can.

So, tomorrow expect the SNP to talk endlessly of the Supreme Court’s decision on another referendum, not the NHS. A decent, caring administration would put constitutional obsessions aside, and get on with the business of government, given the heads of Scotland’s NHS are all but digging the health service’s grave.

This state of collapse isn’t consigned solely to the Scottish NHS, however. Education, policing and prisons – the key domestic pillars of state – are all creaking. What really works in Scotland anymore? What really works in Britain? We’ve two governments that have spent years obsessing over the constitution – be it Brexit or independence – at the expense of good governance.

The SNP and its cult-like base can argue until the cows come home that the state of hospitals, schools and policing is all the fault of wicked Tories – and there may be some truth in that – but the greater truth is that the SNP bears the biggest weight of responsibility. To deflect all blame is sheer transparent cowardice.

Most Scots aren’t partisan idiots who’d see the NHS ruined for the sake of a pitiful political party. Most Scots, like most Britons, cherish the NHS. So the SNP skates on thin ice. No party is indispensable. All governments eventually fall.

If the SNP had any sense – and often it’s hard to believe it does – it would open up an honest national conversation. It would be straight with us; and the straight truth is this: it’s either more tax, especially for the rich, or the end of the NHS. There’s no other choice. But the SNP fears using tax powers as it needs the middle-class onside for independence. Thousands, though, already go private if they can, leaving the poor to sink in an increasingly Darwinian world. This isn’t what a “progressive” party does.

So, the NHS could spell the end of the SNP. Perhaps we’ll see a reverse of the Golden Goose story: rather than the farmer killing the goose, it’ll be the goose who kills the farmer.


From November 21 to November 30 2022 the Herald is running a Black Friday subscription offer which provides full access to our unrivalled coverage of news that matters for just £1. To find out more visit: heraldscotland.com/subscribe


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Arnold Clark to sponsor our Christmas campaign Bank on Us


Arnold Clark is proud to sponsor the Glasgow Times’ charity drive Bank on Us, a festive award-winning campaign that aims to save Christmas for struggling families across Glasgow.

While this time of year is considered a time for celebration, for many families it is a time of stress and worry as they struggle to balance rising costs with the financial strain that comes with the Christmas period.

Many families have to choose between buying food and keeping the heat on, with presents on Christmas day an unreachable luxury. No family should have to make such a devastating choice, and no child should be denied the joy of a happy Christmas day; that’s why Arnold Clark is offering our full support to the fantastic campaign Bank on Us.

Bank on Us has been launched to support the families that need it most and to help make Christmas a magical time for everyone.

HeraldScotland:

Every edition of 3rd December’s Glasgow Times will include a special paper bag which can be filled with your choice of toy. Readers can then deposit this at their local toy bank, a list of which can be found on the Bank on Us webpage.

This simple act can have a huge impact on those who need it, with last year’s Bank on Us campaign delivering over £15,000 worth of toys – around 100,000 gifts – to vulnerable children across Glasgow. This year, they want to do even better, and with Arnold Clark’s support, they will be able to further spread their message and focus on getting help to those who need it.

Sponsoring Bank on Us is just one of the ways Arnold Clark shows its dedication to giving back to local communities. Arnold Clark has been proud to sponsor other fantastic causes such as the Kiltwalk events that are run in conjunction with the Hunter Foundation, of which Arnold Clark has proudly sponsored since 2016.

The Kiltwalk fundraising platform is an opportunity for people to raise money for charities close to their hearts, while also promoting a healthy lifestyle and spreading the good word on tartan fashion.

Kiltwalk events occur annually at cities across Scotland, including Glasgow, Edinburgh and Aberdeen, and each event raises a phenomenal amount of money for the walkers’ chosen charities, which then gets boosted by The Hunter Foundation. For example, the Glasgow Kiltwalk alone raised a record-breaking £4 millions for Scottish charities – £2.7 million raised by walkers and a further £1.35 million provided by The Hunter Foundation.

HeraldScotland:

Arnold Clark also started its own Community Fund in March 2021 to help mitigate the ill effects of the COVID-19 pandemic, providing important financial support to local community groups that were under threat of disappearing during lockdown. Charity and community groups were able to apply for funding from the Arnold Clark Community Fund to help sustain them when it was impossible for them to generate any revenue.

The Arnold Clark Community Fund was such a success, with over 20,000 applications for funding of up to £1,000 to dates, that further Community Fund drives were announced, including a ‘Winter Edition’ in 2021 that was specifically targeted towards food banks, housing and accommodation, and poverty relief to help those most in need during the difficult winter months.

Another way that Arnold Clark has given back to its local communities has been through the building of its Innovation Centres.

The first Arnold Clark Innovation Centre is situated in Glasgow’s West End and is a purely educational space that highlights the benefits of alternatively fuelled vehicles. With no sales on premise, visitors can explore the latest innovations in the automotive industry in a relaxed and supportive environment and discover how making the switch to electric can work for their lifestyles.

Following the success of the first Innovation Centre, Arnold Clark opened a second one at Stafford, giving the public more access to AFV innovation. And this Christmas, the Innovation Centres will be celebrating the festive season with a special event that is open to everyone.

With fun games and activities aimed for all ages, and even a very special Santa’s Grotto, we hope that everyone can make their way to the Innovation Centre Christmas Experience.

Please take part the wonderful Bank on Us campaign, spread the work, and help make Christmas the best day of the year for everyone.

 





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Inverness in line for flights to France under plans by new airline

A French businessman has revealed plans for a newly formed airline to operate a regular service between Scotland and the north west of France. 

The plans would see Lorizon Aircraft operate a three-weekly service between Inverness Airport and Lorient-Bretagne-Sud Airport in Brittany. 

Lorizon Aircraft was founded in July this year by Maxime Ray, a businessman and former president of the Vannes Olympique Club football club.  

The airline has acquired two 37-seat Embraer ERJ 135s, with a focus on regular corporate flights for business travellers. Excess seats will then, in turn, be sold to ‘ordinary’ passengers ‘for attractive prices’. 

READ MORE: Loganair flight bound for Aberdeen diverts to Edinburgh after declaring emergency

Reports in France suggest Lorizon Aircraft invested nearly 8 million euros in the purchase of the two planes, having worked closely with local government office Lorient Agglomération and Morbihan Chamber of Commerce in Brittany. One of the aircraft was delivered last week, after flying with Loganair. 

“These are private flights with a certain number of seats which will be marketed over the counter, by the airport, at a competitive price to discover the Highlands, at the foot of Loch Ness”, Lorizon Aircraft founder Maxime Ray told Le Telegramme.

The French startup airline said the entry into service of the two aircraft will also require the opening of a maintenance centre at Lorient-Bretagne Sud, which will create 14 jobs and attract other airlines. 

HeraldScotland: Lorizon AircraftLorizon Aircraft (Image: Lorizon Aircraft)

Lorizon Aircraft plans to serve three additional airports in France in Paris, Toulon and Lyon in 2023 as part of a ‘rebirth’ of airport activities at Lorient-Bretagne Sud, which has been left with a very limited service after national carrier Air France abandoned operations there in March of 2021.

At present, only one regular commercial flight operates from the airport in APG Airlines’s weekday service to Toulouse-Blagnac Airport. 

Air ITM already operates a non commercial route from the airport to Inverness for sailors from La Scapêche, the Lorient-based fisheries group, while the airport is also used by sports teams FC Lorient and Rugby Club de Vannes for charter flights.

Also known as Lorient-Lann-Bihoué Airport, the airport has a single terminal that can handle up to 180,000 passengers per year and is located in the town of Ploemeur, west of the city of Lorient, in the department of Morbihan, one of the most popular tourist destinations in South Brittany.

At present, Inverness Airport operates two international flights, a KLM service to Amsterdam and seasonal charter flights by TUI to Palma de Mallorca. Loganair are also due to begin operating a seasonal flight to Bergen in Norway in May next year. 

More news on the service is set to be announced by Lorizon Aircraft in the coming weeks. 

Highlands and Islands Airports Limited were approached by The Herald for comment.

Is it really so abhorrent to be charging for NHS services?


Already, Humza Yousaf has said that a two-tier health system would be “abhorrent” (“Health chiefs warn free-for-all NHS model ‘no longer works'”, heraldscotland, November 21). It’s not ideal, but why? The SNP wants to make everything “free” or deploy the more inane term of declaring something a “human right” as if this magically makes it immune to price shocks, scarcity, bottlenecks or abuse.

Do the individuals who work in extractive and chemical industries work for nothing? Do the people who labour on pharmaceutical production lines do it out of duty?

Most of us know services aren’t free, but for some reason, some persist in this naive delusion, helped along by the SNP which has almost entirely ruptured the link between services and taxation.

If I had to pay a fixed sum to see a GP, similar to dentistry, then so be it. I’d rather the entire service works. And I say this from no place of great wealth, working minimum wage for a “free” advocacy service.

However, the NHS Scotland health board chief executives’ minutes are more succinct than me: “divorced from the reality of life and purpose of service”. This could sum up the last 15 years in Scotland.
David Bone, Girvan

SNP response to be applauded

LET’S face it, no one wants to be unwell, no one wants to be taking medication daily, no one wants to be going to hospital. However, unfortunately many find themselves, through no fault of their own, unwell and needing the services of the NHS. So the current headlines regarding the future of our NHS going down the road of charging for certain procedures is alarming.

Many with long-term conditions find themselves relieved that here in Scotland they no longer pay for prescriptions, eliminating the need to make choices of which medication is more important and should be prioritised. The myth that those with long-term conditions and those on benefits were excluded from paying for prescriptions was exactly that, a myth. So, any suggestion of charges for health care would only bring with it additional pressure on the NHS as patients’ conditions worsen due to the added stress of finding the finances.

Humza Yousaf and Nicola Sturgeon have reiterated that the founding principles of the NHS are not up for discussion here in Scotland and this is to be welcomed and applauded considering the financial pressures we are all under, and the current stress on our NHS.
Catriona C Clark, Falkirk

Let us look overseas

THERE can be no doubt that the NHS in Scotland, England, Wales and Northern Ireland are struggling badly in all areas (though the BBC appears to think only Scotland has a problem). The leak that health board chiefs in Scotland held an open discussion on reform should be welcomed, but necessary changes to the NHS will not be instigated at this level, and reform needs to be serious and wide-ranging.

Scotland certainly, but also the entire UK, suffers from general poor health due to climate, diet, lack of exercise and an inheritance of physically-damaged workers due to bad working environments. If the attack dogs in politics and the media could stand back for a moment to allow a serious evaluation of health systems in other countries which seem to function better than the NHS, it would do us all a favour.

The howls of outrage by opposition politicians over health at First Minister’s Questions is a reprehensible disgrace, in that Labour and Tory health ministers where they hold responsibility do not offer better comparable outcomes than Scotland does.
GR Weir, Ochiltree

Don’t let the 3% dictate

LET’S hope that when the Supreme Court publishes its ruling on the referendum on Wednesday (November 23), the legality supports the reality, and the decision remains reserved to Westminster. A common complaint about the Brexit vote is that people were misled and not told “the facts” before the vote. In the case of Indyref2, the facts do not support the idea that Westminster should grant Scotland a referendum.

Referendums are based on total votes for and against a proposition. At the 2021 Holyrood elections, only 64 per cent of the registered electorate voted. Of these, only 49% voted for parties advocating separation from the UK, indicating that only 32% of Scots engaged enough to vote were probable Yes voters. Furthermore, of the last 51 polls on independence, only six have shown a slight majority for Yes.

There are few facts to consider on the issue of what Scotland’s status would be after separation. This can only be determined after a long, complex negotiation involving the politicians, civil servants and lawyers of both governments – a huge distraction and at considerable expense, with businesses reluctant to invest amidst the uncertainty. The Brexit experience demonstrates that years after the vote there are still negotiations ongoing, and we still do not know the true extent of the resultant damage or possible benefits.

The UK Government has a responsibility to the entire UK population and together with Holyrood has more urgent problems to deal with than at any time in recent history. To allow less than three per cent of the UK electorate to impose this needless distraction on the rest would indeed be a “democratic deficit”, a term the SNP are very fond of.
Mark Openshaw, Aberdeen

They will find new grievances

ON Wednesday the Supreme Court is scheduled to deliver its verdict on the SNP’s demand for another referendum. The general legal consensus appears to be that the nationalists will be given a flea in their ear. The fact that nationalist protest rallies are being organised by the usual suspects on Wednesday speaks volumes. We have already heard the first rumblings of “biased judges”. The script appears to have been written and it does not seem to matter that one at least of the Supreme Court judges is a Scot.

Be that as it may, the issue will not then be put aside and infinitely more important matters tackled at long last. The FM’s taxpayer-supplied and funded multi-million-pound SPAD army will not turn to using their brains to help solve Scotland’s myriad and deep-seated problems and suggest, for example, curtailing profligate spending on nationalist shibboleths and use the money instead to help pay fair wage claims and aid the poorest and most vulnerable in our society.

They will instead be employed in attempting to find any new grievance whatsoever to help their obsession with breaking up the UK, to the exclusion of all else, and the weary people of this country will be faced with further years of division and festering hatred and misery.
Alexander McKay, Edinburgh

Focus on fixing Brexit damage

RUTH Marr (Letters, November 19) has correctly identified a mood in the country in which a majority of people agree with Ian Blackford’s withering comments regarding Brexit. However, her complaint about the Labour Party’s policy to keep the UK out of the EU is misplaced.

We all, including Ms Marr, have to accept that the UK is out of the EU, and we cannot rejoin in the near future, even if well over three-quarters of the population want to do so. There is no point in Ian Blackford and the Labour Party having a policy to rejoin the EU. The Labour Party in particular must develop a policy which reverses the damage inflicted on the UK from a disastrous Brexit agreement. A commitment to realign the UK with the EU in order to eliminate trade barriers would be a helpful start, even if there is no guarantee that the EU would be willing to accept such a change in attitude.
Sandy Gemmill, Edinburgh

No comparison with Croatia

WHY does Alan Sutherland (Letters, November 21) assume that the SNP and Greens would govern an independent Scottish nation and why does he liken Scotland, a nation ripped out of the EU by its neighbours in peacetime, to Croatia, a nation newly emerged from the carnage of the Balkan wars?

No political party or candidate will be mentioned on the voting paper in an independence ballot and all parties would be free to compete to participate in the government of a newly-independent Scottish nation under proportional representation. The “Disunited Kingdom”, rather than Scotland, would become an outlier among the nations of western Europe.
Willie Maclean, Milngavie

• ABRAHAM Lincoln said: “When you reach the end of your rope, tie a knot and hang on.”

Desperation can make folk do surprising things, but weaponising the twin disasters that were Liz Truss and Kwasi Kwarteng as a reason to remain in the Union?

I would suggest that Peter A Russell (Letters, November 21) seeks a better knot?
Alan Carmichael, Glasgow


Read more letters: National Care Service plans pose a threat to standards


HeraldScotland:

Letters should not exceed 500 words. We reserve the right to edit submissions.






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Minimum pricing Scotland: ‘effective’ in reducing alcohol consumption


Minimum unit pricing has been effective in reducing alcohol consumption in the three years since it was implemented, according to a report.

The latest data showing the impact of minimum unit pricing (MUP) was published in a report on Tuesday by Public Health Scotland, showing a 3% net reduction in sales per adult in the three years following the implementation of the policy.

This was driven by a reduction in per-adult sales of alcohol through the off-trade in supermarkets and off licences, the report stated.

Maree Todd, Scotland’s public health minister, said: “Minimum unit pricing is achieving what it set out to do – a reduction in sales overall with a focus on the cheap high-strength alcohol, which is often drunk by people drinking at harmful levels.”

The research follows an earlier report which demonstrated a similar fall in off-trade alcohol sales in the first 12 months after the implementation of minimum pricing and allowed for adjustment including geographical control and for Covid-19 associated restrictions.

HeraldScotland:

Sales of cider, perry, spirits and beer have seen net reductions but there have been net increases in the sales of wine and fortified wine such as Buckfast.

Figures were based on the total volume of pure alcohol sold, both through pubs and in off licences.

Lucie Giles, Public Health Intelligence Principal at PHS, said: “The overall impact of MUP on total per-adult alcohol sales in Scotland was a 3% net reduction, driven by a reduction in off-trade sales.

“We found little evidence to suggest that MUP caused any changes in per-adult sales of alcohol through the on-trade, suggesting that MUP did not cause a substantial shift towards alcohol consumption in pubs.

“Our main finding was consistent across a range of different conditions as tested through our additional analyses.

“We can conclude that, across Scotland as a whole, MUP has been effective in reducing alcohol consumption in the first three years of implementation.”

The report was compiled in collaboration with the University of Glasgow.

Jim Lewsey, Professor of Medical Statistics at the School of Health and Wellbeing at the university, said: “The methods we’ve used in this study allow us to be confident that the reduction in per-adult alcohol sales that we’ve shown is as a result of the introduction of MUP, rather than some other factor.

“Incorporating data from England and Wales into our analysis controls for any changes in sales in a neighbouring region where the legislation was not introduced.

“This was of particular importance with the Covid-19 pandemic occurring in our three-year, post-intervention study period, as we know the pandemic impacted on where people were able to purchase alcohol.

“We’ve been able to adjust for other factors, such as household income, sales of alcohol through pubs and clubs and of other drink types.

“This statistical method also allows us to take into consideration any existing trends and seasonal variation in the data, which may have existed independently of MUP, but which could have impacted on alcohol sales following its introduction.

“The methods we’ve used and the consistency in our results allow us to be confident that the reduction in alcohol sales is associated with the introduction of MUP in Scotland.”

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Now is the time for a root and branch review of our health service



I HEARD the story about Scotland’s NHS board chief executives pondering the possibility of better off people paying for their treatment via Kaye Adams’ phone-in on BBC Radio Scotland.

All credit to the BBC’s James Cook for breaking an important story. However, by yesterday morning it seemed there was an edict to issue a pronunciamento at three-minute intervals distancing the Health Secretary, Humza Yousaf, from any such policy. This seemed a little excessive since nobody attributed the idea to him in the first place.

Anyone who listened to the programme might have concluded that Mr Yousaf was protesting too much. It may, as he said, be “abhorrent” that people should be asked to pay for treatment nominally available through the NHS. However, it is also the reality that this is happening on a rapidly growing scale.

That is not due to ideological choices on the part of patients or the Scottish Government. Overwhelmingly, it results from the inability of the NHS in Scotland, for which Mr Yousaf is responsible, to deliver the prospect of treatment within any reasonable timescale. Calling the logical outcome of that failure “abhorrent” does not make it go away.

The private healthcare sector is booming while the NHS is struggling under the weight of demand and under-staffing. For the great majority who cannot, even in extremis, turn to private provision, the alternative is often the burden of ongoing pain, distress and deteriorating conditions. There are a lot of “abhorrent” outcomes when our NHS is unable to provide.

In these circumstances, it was right for Caroline Lamb, chief executive of NHS Scotland, to give the “green light to present what boards feel reform may look like” and advise that “areas which were previously not viable options are now possibilities”. That, at least, is what the minute attributes to her and such open discussion should be welcomed.

Now it is in the public domain, the content of that discussion can serve a useful purpose as a launchpad for debate. It clearly allowed views to be expressed which are normally withheld for fear of offending the politicians but which are actually much closer to reality than the PR that comes out of St Andrew’s House. Insofar as we already have a two-tier health system, that should be acknowledged.

While it was understandable that the headline coverage highlighted the “better-off should pay” aspect of the chief executives’ think-in, there was much else in the leaked minute which Mr Yousaf cannot dismiss through rhetoric or mere abhorrence.

The fundamental challenge was set out succinctly. Describing a “billion-pound hole” in the budget, the minute warns that it “is not possible to continue to run the range of programmes” the NHS currently offers while remaining safe “and doing no harm” … “Unscheduled care is going to fall over in the near term before planned care falls over.”

Other extracts read like a counsel of despair from health board chief executives about the relationship with their political masters in Edinburgh. There is a “disconnect from the pressure that the boards are feeling and the message from Scottish Government that everything is still a priority and to be done within budget”.

Furthermore, the minutes note “concern” about an alleged lack of clinical input into political decision-making which, they say, leaves the Scottish Government often “divorced from reality of life and purpose of service”.

There is an intriguing reference to “siloed discussions ongoing within Scottish Government” that exclude health professionals. “Fundamental reform” of the primary care model “must be on the table”, while the success of the NHS has been built on a model “that no longer works today”.

The depth and range of these sentiments will come as no surprise to anyone who speaks to people who work in the NHS. They know that the structure around them is becoming more fragile by the month and, no matter how long, hard or caringly they work, the odds are increasingly stacked against them.

Money alone is not the problem, though it always helps and that “billion pound hole” needs to be explained. Last year, the Institute for Fiscal Studies reported that whereas the gap between per capita spending on health in Scotland was 22 per cent higher than in England pre-devolution, it had now narrowed to three per cent. Why has this happened?

From the day it was created in 1948, the NHS in Scotland had autonomy to set its own priorities, influenced by our scattered geography and industrial history. The Barnett formula helped ensure it was well funded in both absolute and relative terms. Now the same formula brings the same proportionate share to Scotland but it is up to the devolved Government to decide how it is spent.

The translation of Barnett consequentials into budget headings is infamously opaque but has certainly contributed to that “billion pound hole”. The least Scotland was entitled to expect was that every penny generated by NHS spending elsewhere in the UK should be committed to NHS spending when it reached Scotland. That did not happen.

Like everywhere else, we have an ageing population which demands a coherent vision for the future. One key element is staffing yet, despite years of warning, we neglected to train enough nurses, so Scotland is now 10% short, with the exodus accelerating. Why did Scotland stop training its own nurses and how can this be reversed? These are practical questions that must be addressed.

Scotland, like everywhere else, needs an honest, fundamental review of how health care is to be funded and provided for years ahead. Just as in the NHS chief executives’ meeting, there must be room for radical thinking, not least about how much we are prepared to pay for a 21st century NHS whether through taxation or by other means.

Whoever leaked this document has performed a real public service. Let’s now see how Ms Sturgeon – who was Health Secretary for five fateful years – and Mr Yousaf respond to it. There must surely be more than denial and cliché.


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