The spectacle of Nicola Sturgeon on the warpath, advancing with a fresh round of shocking health statistics, has become part of the fabric of Scottish political life. As the Scottish National party’s deputy leader and their champion at Holyrood, as well as a former health spokeswoman, she has made health her issue, repeatedly inflicting damage on the Scottish executive over its poor performance on all matters health-related.
It is largely thanks to Sturgeon, sparring with percentages and brandishing bed numbers, that health has dominated the political debate — ad nauseum. During this year’s general election campaign, nothing hurt Jack McConnell’s administration more than revelations about devolved Scotland’s health record, especially in light of England’s. McConnell was put in the uncomfortable position of having to defend Scotland’s lack of achievements against what Tony Blair called “empirical evidence” that his reforms were working.
This week Sturgeon has been at it again. She accused the executive of fiddling the figures on hospital waiting lists to hide the nearly 17,500 people who are being forced to wait more than nine months for treatment. Although Andy Kerr, the health minister, claimed that official waiting times had fallen, a “hidden” list, said Sturgeon, proved the opposite. She fumed about a “smokescreen of spin”, charged Kerr with “a cruel deception”, and demanded an investigation by the auditor general.
Now, there is no doubting her vigour, or her conviction, but there came a point during this latest exposé when many people’s eyes must have glazed and their brows knitted. Those viewers who have trouble sleeping and may have inadvertently tuned into Sturgeon, and then Margaret Curran for the executive, on Scottish Newsnight on Tuesday could be excused their bafflement.
What is an availability status code (ASC) and do patients assigned it get put to the back of the queue? And by excluding this category from official lists (if that is what has happened) have ministers manipulated the truth? Patients may well have been cast into a bureaucratic “outer darkness” — so have we all. How do we gauge the success or failure of the Scottish NHS? How can the man on the street distinguish between average and median waiting times? Until quite recently, the executive refused to release details of average waiting times. Instead, it used what it called the median method of calculation — the halfway point between the longest and shortest waits. The median waiting time rose to 43 days for inpatients in the third quarter of last year (up 13 days since 1999) and to 55 days for outpatients. Meanwhile, average waiting times for inpatients were up 50% in the same period. If you measure median waiting times, you wait less than if you measure them by average waits, but either way you have to wait too long. Are you still with me? Kerr said the median waiting time gives a more appropriate picture, because averages are skewed by a small number of unusually high times. But the suspicion, I’m afraid, is that all the figures are skewed wherever possible to suit politicians’ targets. What other conclusion can be drawn when the presentation is so hopelessly opaque? The suspicion, too, is that, despite huge investment in the NHS since devolution, health and health provision in this country have not improved. Waiting times aside, Scotland is the cancer capital of Europe; we are in the grip of a lung cancer epidemic; it is the obesity capital of Europe; life expectancy is lower than it is in England; maternity units are being closed because of a nursing crisis; at-risk babies are three times as likely to die within a week of birth in parts of Scotland than in southeast England.
Faced with such pressing health problems, doctors are not very interested in how waiting times are measured, but in how the health system can cope.
“The difficulty in Scotland is a relative lack of capacity in the NHS in terms of nurses, doctors and other staff; resources and equipment,” said Clive Davis, chairman of the British Medical Association’s Scottish consultants’ committee. While politicians use statistics to score political points, doctors are busy listening to the concerns of patients.
There have to be some statistics, however. We need to be able to hold the health minister to account for failings in the system; we need to keep him on his toes.
Currently, figures can be obtained from the executive’s health statistics division, ISD Scotland. This is how Sturgeon found out about waiting times for ASC patients. A spokesman said there was no secrecy about ASCs or, presumably, about any other health statistics. He said they are going to abolish them (ASCs — not statistics) anyway by 2007 to make the “whole system clearer, more consistent and fairer to patients”.
This is, perhaps, a credit to Sturgeon’s persistence, but in order to reassure the public that it is not being taken for a ride whenever McConnell stands up in the parliament to trumpet his “commitment to cutting waiting lists”, the statistics need to be more than clear. They must be believable. And the only way to produce official health statistics that are believable is to remove them altogether from the remit of politicians.
We don’t need another quango of Labour apologists, but how about an independent institute, possibly attached to a reputable university — say, an Institute for Plausible Health Performance Indicators (or IPHPI) — run and staffed by statisticians with no known political bias? Its task: to produce regularly updated data and analyses of waiting-list rises and falls, of outpatient and inpatient treatment guarantees and so on, in plain, jargon-filtered, apolitical English.
Of course, this may create yet another raft of public sector jobs, but if Scotland can afford a National Centre for Confidence (established in March with £450,000 of public money), surely it can afford to sponsor an institute that employs a handful of academics to chart, intelligibly, the progress of its health service. Then, when the leader of the opposition (or anybody) chooses health as the weapon with which to bludgeon the government, we will not be fobbed off with waffle, fairy-tale figures and the selective use of English statistics.
And the health boards and medics and other health professionals, freed from having to verify statistics they probably don’t understand any better than we do, could get on with their jobs — of delivering healthcare to the country.
