SCOTLAND'S HEALTH CRISIS
After fourteen years in office, the SNP cannot simply blame the pandemic for the nations litany of health woes
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SCOTTISH Health secretary Humza Yousaf has repeatedly pledged that the Scottish Government will “leave no stone unturned”1 as hospitals try to clear the huge backlog in treatments. And in fairness to the Health Secretary, we should acknowledge the devastating impact of the pandemic on healthcare.
But we know, and can prove, that healthcare under the SNP was poorly placed on the eve of the pandemic’s arrival to meet the challenges. And it isn’t the fault of any doctors, nurses, carers or hospital administrators either.
Whether it’s waiting times, delayed diagnoses, or backlogs in operations; the pandemic has created many critical challenges. But nevertheless, it becomes important to point to the Scottish health data indicating longer term problems which predate the pandemic. We must not allow the Holyrood administration to rhetorically hide more engrained failings beneath the cloak of a Covid-19 pandemic.
For the sakes of providing a deeper dive analysis coupled with brevity, I’ll restrict myself to examining two aspects of pre-covid healthcare failings on the Scottish Government’s watch: bowel cancer screening and A&E waiting times.
SCOTTISH BOWEL SCREENING PROGRAMME
One such example of deeper underlying failings in healthcare provision in SNP-governed Scotland would be the nation’s bowel screening programme. We can know as a fact that there have been sustained long term failures regarding bowel screening for cancer that goes to deeper failings and causes before and beyond the impact of the Covid-19 pandemic.
On Wednesday, February 9th, Jackie Baillie asked Portfolio Question Time to Health Secretary Humza Yousaf about the gap between deprived and least deprived accessing bowel screening for cancers in Scotland,
“I wonder whether I could push the cabinet secretary slightly further on that point. There is a shocking 20 percentage point gap in bowel cancer screening between the people in the most deprived areas and those in the least deprived areas. It is, indeed, a matter of great shame that the most deprived in our communities remain at greatest threat due to late cancer diagnosis. We already know that, since the start of the pandemic, almost 30,000 of our fellow Scots have died from cancer. I want to press the cabinet secretary on the issue. What urgent action is the Government taking to encourage the uptake of screening across all cancers in our most deprived communities?”2
We know that the pandemic will have caused disruption regarding accessing bowel cancer screenings. But, as Jackie Baillie implies in her question, there is a gap between least and most deprived accessing screenings. And this is an interesting place to dig deeper.
According to Key Performance Indicator (KPI) Report from August 2019, we discover -prior to the pandemic’s arrival - a number of disparities in uptake regarding bowel cancer screening.
In the data there are two tests conducted to screen bowels, the Faecal Immunochemical Test (FIT) and Faecal Occult Blood Tests (FOBT). And the Scottish Bowel Screening Programme started using FIT kits instead of FOBT from 20th November 2017. The rationale is perhaps FIT theoretically should lead to higher uptake in screening as it involves taking just one sample on one occasion, compared to the FOBT which requires two samples to be taken on three separate occasions3. And if you’re anything like me, an element of disgust enters the mind when collecting faecal samples once never mind more than once.
When we examine the 2019 Scottish KPI Report4 on bowel screening uptake we discover, just as Jackie Baillie referenced, a significant gap between poorest and wealthiest Scots uptake regarding bowel cancer screenings.
Looking at figure 1, we can see prior to the pandemic a major imbalance on uptake in bowel cancer screening based on income. Most deprived only had a 51.7% FIT uptake, whereas the least deprived at 72.5%. That is a 20.8% gap, just as Jackie Baillie said in her question to Humza Yousaf 9th Feb 2022.
This in of itself proves that the Scottish Government has been failing woefully to increase bowel screening uptake among the most deprived Scots. And failing at scale long before the pandemic even hit.
But the KPI Report indicates that the 2016 claims by academics and researchers that FIT tests would have higher uptake than FOBT is absolutely vindicated. This is a positive point to be noted.
Figure 2 vindicates using FIT over FOBT, as it reduces public disgust, increases propensity to cooperate with bowl cancer screenings. So, credit where credit is due, that from November 2017 the programme had begun switching over to FIT. This perhaps is an aspect in improving those devastatingly bad uptake percentages among the most deprived.
But the bottom line here is, the Scottish Government was presiding over a gap of 20.8% between most and least deprived regarding bowel cancer screening. All prior the the pandemic. This is an empirical fact, and should not be lost in the wash as politicians, naturally enough, begin to shift over to discussing the Covid-19 consequences.
SCOTTISH A&E COMPLIANCE WITH THE 4 HOUR STANDARD
Another underlying failure on the SNP’s watch has been an abject failure to move the dial regarding compliance with the 4 hour standard.
The ‘4 hour standard’ references the Scottish Government’s self-set target percentage of A&E patients to be either admitted, transferred or discharged in four hours. Their target has been 95%. Unbelievably, the SNP government has not met their 4 hour standard target since July 20175.
As figure 3 reveals, 16th July-August 6th 2017 were the last period where the Holyrood administration succeeded in achieving their A&E waiting time target.
Furthermore, since August 2017, Scotland’s A&E waiting time compliance fell precipitously from 94.1% August 6th 2017 to just 77.8% by January 7th, 2018. Just look at figure 4 as proof of this staggering falling-off in A&E waiting time performance.
There was no global health pandemic in the time period August 2017-January 2018. But there was the same SNP government led by the same First Minister.
What is more, on the eve of the pandemic’s arrival, on December 15th 2019, the A&E compliance to the 4 hour standard was only 78.9%. Thus, from July 2017 through to the eve of the pandemic’s outbreak in Scotland, Nicola Sturgeon presided over a collapse of A&E waiting time targets from 95.2% to just 78.9%.
We can make a few conclusions on this basis, not least Scotland’s A&E was struggling under this SNP government long before the pandemic. Indeed, in another article in the past I explored the legacy of pre-covid SNP cuts to Dumfries & Galloway NHS.
Dumfries and Galloway NHS, prior to the pandemic had to wrestle with the necessity to make ‘savings’ (i.e. cuts) due to a £17.3m funding gap6 Don’t imagine for a second that the plight of Dumfries & Galloway NHS is an isolated case either. It is not unreasonable to suggest a link between pressures on Scotland’s NHS to make ‘savings’ and falling A&E waiting time target compliance. But don’t blame hospital administrators, staff or patients either. Blame the central government in Holyrood.
CONCLUSIONS
Nicola Sturgeon’s administration had presided over serious failings in our health system, which the pandemic has worsened. But the underlying issues predate the Covid-19 virus.
We know that this incumbent SNP administration has failed to solve the bowel cancer screening testing uptake imbalances based on deprivation. We know that it has presided over chronic and sustained failures regarding A&E waiting time targets. And we also know there has been a legacy of cuts, pressures in some hospitals to obtain ‘savings’ - all prior the covid pandemic.
Do not let the SNP get away with simply parrying the blame to the pandemic. The facts speak for themselves, keep them in mind when you vote in the May local elections this year; make your vote count.
Article updated 18/02/22 at 2:13pm to correct a few spelling errors, ‘bowl’ in a few paragraphs changed to ‘bowel’. This means the emailed version of this article will have the mistaken spelling
McCall Chris, (2021, November 24), ‘NHS Scotland will 'take years' to fully recover following pandemic, admits Humza Yousaf’, Daily Record, https://www.dailyrecord.co.uk/news/politics/nhs-scotland-take-years-fully-25532563
Meeting of the Parliament (Hybrid) (2022, February 9), Portfolio Question Time, Health and Social Care, https://www.parliament.scot/chamber-and-committees/official-report/what-was-said-in-parliament/meeting-of-parliament-09-02-2022?meeting=13579&iob=123210
Chambers Julie A., Callander Alana S., Grangeret Rebecca, O’Carroll Ronan E. (2016, February 13), ‘Attitudes towards the Faecal Occult Blood Test (FOBT) versus the Faecal Immunochemical Test (FIT) for colorectal cancer screening: perceived ease of completion and disgust’, BMC Cancer, https://bmccancer.biomedcentral.com/articles/10.1186/s12885-016-2133-4#:~:text=One%20of%20the%20main%20differences,taken%20on%20three%20separate%20occasions.
‘Scottish Bowel Screening Programme’ (2019, August), KPI Report, Public Health Scotland, https://www.isdscotland.org/health-topics/cancer/bowel-screening/
‘NHS Performs - weekly update of emergency department activity and waiting time statistics’, Public Health Scotland, https://publichealthscotland.scot/publications/nhs-performs-weekly-update-of-emergency-department-activity-and-waiting-time-statistics/nhs-performs-weekly-update-of-emergency-department-activity-and-waiting-time-statistics-week-ending-6-february-2022/
Thomson Dean MacKinnon (2021, December 11) ‘NHS Dumfries & Galloway is under pressure and the SNP is to blame’,