Better Health, Better Care- a Better Document

First, apologies. I do realise that I have not blogged for a couple of weeks. This is because rather a lot has been happening at this end and I have been running around like a blue -bahookied fly. But time to get back to blogging and my bedside reading just now is this document - 'Better Health,Better Care'. It's a discussion document that was brought out by the Scottish Government in August and submissions are due in November.

Documents like this are tricky to get right. Too much detail,and you are accused of having already drawn your own conclusions. Too little, and you are accused of having nothing to offer. This document has got the balance just right.

There are several specific targets

Abolition of prescription charges; direct health elections;an end to hidden waiting lists; free school meals;a new dental school in Aberdeen; a waiting time no longer than 18weeks from referral to appointment;

It has a specific policy direction

The document has statements like 'There will be a clear policy presumption against centralisation'.

It is ambitious

This is a wide ranging document. It is looking at every area of healthcare and has the feeling of ambition about it. In modern politics it's very difficult to have a big idea or big government. Politicians are accused of bringing in the nanny state when they do this. If they fail in any of their objectives, then this is forever cast up to them. Politicians have therefore been careful-too careful in my opinion, to go for it, and attempt make a real difference; they end up picking around the edges of legislation, rather than attempt something that may leave them exposed to criticism. This document throws that approach out of the window. It is a breath of fresh air.

It is in plain English.

Not a sign of 'synergy' anywhere. Need I say more?

I will be discussing this document over the next few posts, and how the aims in it might be achieved. Watch this space!

Parking Mad

Another bit of welcome news - Nicola Sturgeon announced today that there would be a review of car parking charges at hospitals. I was a witness at the Health Committee meeting that was held about this last June in Holyrood and I was distinctly unimpressed by the reasons given for having a charge in the hospital car parks. Basically, the argument went that there was all these fly parkers going in so the charge had to be imposed. The fact that the fly parker would pay for his ticket and then leave it there for the rest of the day, didn't seem to bother Consort. All suggestions about having a barrier, car park tokens, showing your appointment card and all the things that are used at public buildings as a matter of course to prevent this problem, cut no ice with the car park owners. Staff that were travelling to the hospital, were having to pay; in effect having £500 docked from their wages before they even crossed the threshold of the door. There was a suspicion that these charges esp at the Royal Infirmary of Edinburgh, were being used to pay for the interest on the PFI loan that built the hospital.

However, this problem is rather more complicated than it would first appear. One of the features of modern hospitals is that they tend to be built out of town. This is because some years ago, capital charging was introduced on NHS properties, to encourage the NHS to get rid of buildings that it wasn't using. So if you had a hospital in town ie Glasgow Royal Infirmary, then the capital charge on that would be prohibitive. If however, you had a hospital out in the middle of nowhere like Hairmyres, then the capital charge would be much lower. So the NHS started building out of town.However the downside is that many of these hospitals do not have good transport links and the only practical way to get to them, is by car.

One of the worrying features of this, as I mentioned in a previous post, is what would happen if you needed all your staff if there was a major incident. By definition, none of them would live near the hospital, and all of them would have to travel a considerable distance to get to the hospital. If the incident occured on say, the M8 and you had to travel along it to get to the hospital, what then?

If the hospitals want their staff to leave their cars behind, they are going to have to rethink their transport links, and on a wider scale, the government is going to have to rethink the whole centralisation issue. Bigger isn't always better. However, there is one thing that could be done fairly easily to encourage people to travel by public transport; re-man railway stations at night, and bring back bus conductors. It would make everyone feel a lot safer, and cut out most of the boorish behaviour and vandalism that we have come to accept as normal on trains and buses. You don't believe me? Well, when I was going to school in the eighties, I travelled on the trains when the stations were manned; there was very little bother on them. When they de-manned the stations, within weeks, gangs of neds appeared on the trains and by the end of the year every station from Coatbridge to Glasgow had been burnt down. Its time for a review of this, and time for a review of transport in general.

Straws in the Wind

In the last two weeks, while all the shenanigans about who was going to be the next Labour leader was going on, a smaller but very significant battle was going on in NHS Lothian. John Cochrane, who is one of three councillors elected on a hospital ticket for St Johns in Livingston, had been nominated to the health board. NHS Lothian objected furiously. Nicola Sturgeon intervened and the health board backed down. John is now on the board and there is nothing NHS Lothian can do about it.

Why is this so important? It's only one vote after all, and ultimate authority lies with central government.
It is important because it means that the health board can no longer conceal information about PFI contracts and the like from campaigners, under the catch-all of commercial confidentiality. It means that public money that is being spent on these contracts, will be publically accountable. It is a huge step forward. All due credit to Nicola Sturgeon for supporting them.

Some months ago, Bill Butler put forward his Health Election bill, which our group was involved in. It was to allow people to be elected directly onto their local health board, instead of the board hand picking them from the usual suspects. The board would have a majority of elected members, but would have seats set aside for medical experts. Not surprisingly, it lost, but maybe there will be a re-appearance. But good on St John's. They've cut to the chase, and I predict that in the next couple of years this will be seen as one of the most significant moments in the health battle. Go gettem John!