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BRYAN WEBSTER says the old lady sitting in the Health Centre doesn’t need Audit Scotland to tell her that the NHS in Scotland is in a mess…

She suffers from it.

This is the fourth time in a fortnight she has been summoned to the Centre: once to have her Warfarin checked, once to have her blood pressure taken and her urine sampled, once for her flu jab and now to see the doctor.

She has no interest in the Audit’s big picture: not the £11.1bn spent by the Scottish Government on Health in 2013/14, nor the 367,259 outpatients that were seen in the quarter ending March 2014, and is not at all comforted by the fact that ‘the Scottish Government is reviewing the HEAT framework and aims to have guidance for (health) boards by November 2014’.

Yet her experience gives us a much better handle on what is wrong with NHS Scotland than the carefully weighted words of the Audit Report.

For Audit Scotland nowhere puts its finger on the true cause of failure: the management system employed by the government to manage Health Services in Scotland.

This reminds me of Westminster politicians in the 1830s who continued tinkering with London’s sewage system until in 1837 Disraeli and MPs were forced from their deliberations in the Houses of Parliament by the stink drifting in from the River Thames.

Certainly, there is a stink.

We read almost every day of blunders and neglect in the NHS.

Audit Scotland sniffs it in missed targets for waiting time; strained budgets, long waits in A&E, Health Boards bailed out by the government, and ‘demand for outpatients appointments increasing faster than the number of patients seen’, etc.

GPs and other health staff complain of it in their constant complaints about stress and overbearing managers. It pollutes Health Centres too, as even relatively small ones have to set aside the equivalent of one member of staff to feed information back up to the Health Bureaucracy.

But the stink still has not penetrated the corridors of Holyrood where Health Secretary Alex Neil sprays platitudes on every new instance of negligence and slaps sticking plaster on the system to keep it going. And all the time he solemnly swears that the service is and must always be, ‘person-centred’.

Oh, no it isn’t!

I am sure that Mr Neil wants it to be person-centred. Perhaps he believes it is, but the little old lady knows it is not - for if it were, she would not have had to trail to the Health Centre four times in a fortnight, anxious every time that this time something nasty, cancer perhaps, or dementia, will be picked up.

Hopefully she does not know that that GPs are paid for picking up dementia patients. In England they get £55 a skull; in Scotland just a little something in the general package to keep them looking and following government guidelines.

The management system employed by the NHS always tended to Command and Control (or, as it is now called, Performance Management), but it received a huge boost in 2004 when the care of patients 24/7 was transferred from GPs to Regional Health Boards.

Since then, successive governments have assumed that it is their job not just to fund the NHS but to ‘manage’ it.

 My hopes that this might change were raised a few years ago when, at an Alert Event, Nicola Sturgeon - now our First Minister, then Cabinet Secretary for Health - chopped off a critic with ‘I can’t be in every ward, every GP surgery.”

Had she grasped that thought and pushed it she would have disbanded the central planners and given every health worker the power and resources to do what they see needs doing. She would have assumed that they were at least as concerned as she was to do the best they could for the person in front of them.

But this flicker of insight was snuffed out, no doubt in meetings attended only by those who think in headings in a strategic plan, under several of which the little old lady may be slotted, but into no one of which she can squeeze her whole self.

For as she sits forlornly in the waiting room doesn’t the bright new electronic messaging screen above her request that, seeing as the doctor only has 10 minutes to see her, she should ‘raise only one problem at a time.’


Bryan Webster is an award-winning writer on management.