Siol nan Gaidheal
The Health of the Nation
Question to the Scottish Parliament, November 1999:
Kay Ullrich, Shadow Health Minister; “What plans does the Executive have in place to ensure that there is no winter crisis this year?”
Susan Deacon, Health Minister; “There is a freephone help line in place.”
In an independent Scottish society, health care should be freely available to all. This is what was originally envisaged when Lord Beveridge commenced the National Health Service in 1947, and in a fashion this did continue for some years thereafter. Strains started to show in the early 1970’s, and from then on a continuing process of erosion took place, accelerated by Thatcher’s election victory in 1979. During the Tories’ reign, the Health Service was dismantled piece by piece and “privatised” by the introduction of the NHS Trusts and competitive tendering for previously supplied “in-house” services. Since the “new” British Unionist Labour Party gained power in 1997, on a manifesto promise of protecting and strengthening the Health Service, this process has not been halted or slowed down, but has in fact been accelerated in some areas, to the detriment of the NHS (sic) as a whole. In Scotland, more than 1600 hospital beds have been lost since Labour took over, including some intensive care beds. Yet health spending in England is rising at two-and-a-half times the rate it is in Scotland.
On gaining independence, the original concept of free health care for all should be restored. However, it must be on a rational and proportioned basis, as the demands on health care can be almost limitless. This winter has already shown how stretched our health resources nowadays are, and some degree of balance must be restored. Winter happens every year, whether those who allocate these resources wish it to or not, and the seasonal influx of the elderly and infirm is not an unusual one. The reasons for this may be addressed in a more proactive fashion, relieving the strain on the finite resources of the health service.
Several strategies may be employed to aid this aim. It is a proven fact that Scottish winters are more severe than those in England, yet the Westminster-based decision makers do not condescend to recognise this, and every year many elderly people in Scotland are forced to make the grim choice of either starving, or freezing to death. A society that ensured the elderly population are adequately catered for in the provision of heating, by whatever means, would therefore remove such a dilemma for that particular group, freeing up a large portion of their budget for the basic essentials of life. Adequate health education for all, and the removal of the “poverty trap” would also relieve the stress on a burdened health service. The link has long been recognised between poverty and disease, from many years before the introduction of health care. Ensuring the removal of real poverty will in the long term bring positive health benefits to Scotland, and reduce further the burden of cost.
The poverty trap also works in more insidious ways, affecting the mental health of those caught up in its bind. To be poor and unemployed in Scotland means to run a five times higher risk of developing a psychiatric illness than in the general population as a whole. Depression removes incentive, confidence and self-respect, reinforcing the condition and ensuring the victim has little real chance of escaping the grasp of the illness. Care in the community is grossly under-funded, and many people suffering quite serious mental illness go untreated or inadequately treated. Read through some of the entries in the Siol nan Gaidheal Forum if you doubt this! Joking aside, however, a society which cannot protect its most vulnerable citizens is in a sorry state. The old Scottish traits of neighbourliness, lending a hand and safeguarding those less fortunate than ourselves are being swamped in a tide of apathy.
Multinational companies promote the fallacy that bottle feeding is more convenient than the method which Nature chose to provide, and midwives in our hospitals daily face the dichotomy of promoting breast-feeding but handing over packs provided by these companies in order to enslave young women from the very start of their child’s life. These packs are not provided out of the goodness of the company’s heart, but to ensure a constant stream of profit from those whose expenses have already started to spiral, often out of control. This further reinforces the trap of poverty, and dooms many to constant draining expense for a resource that Nature provides free of charge.
Health education needs to be approached in a less hectoring fashion than hitherto – ensuring that young people really understand the positive benefits of a healthy diet and regular exercise, and removing altogether the notion that “chips’n’ginger” is a major food group! The curbing of activity in certain sections of the fast food industry would be a positive start here. Pitched solidly at the least discriminating members of society, our children, they encourage the use of the “pester factor” in their advertising to fool children into demanding their products. Promoters of the lowest possible wages, whilst serving up inedible and wholly non-nutritious pap, these multinationals should be encouraged to either clean up their act (unlikely) or move elsewhere. The fact that one of these bears a once-proud Scottish name is a particular source of shame. Malnutrition, once held to be a spectre of the past, is now widespread, as recent figures show that one person in eight in Scotland admitted to hospital is suffering from malnutrition. A Parliamentary motion, "Malnutrition in Scotland: A Public Health Problem", is being lodged in the Scottish Assembly at present. That this condition can arise in a so-called wealthy and civilised society must be a cause for grave concern.
Based on the Finnish model of health education, the incidence of heart disease could be drastically reduced in a single generation. Once top of the league for coronary problems in the Northern hemisphere, through a systematic programme of health education and modification of diet, Finland has drastically reduced its heart disease problem. Scotland now has the dubious distinction of leading the league in this health area, not a position to be proud of. The Finns started their programme at nursery level, with children learning about a healthier lifestyle from the time they were four years old. Their government put its full weight behind this campaign, and the results have been quite startling. Scotland could learn a lot from studying this role model.
According to recent SNP figures, spending on health in Scotland is less than the equivalent figure for England and Wales. Tony Blair has pledged to increase spending for the NHS (sic) in England and Wales by 5% to reach European Union average spending levels (though this is still well below the figures in France or Germany). Funding for the NHS (sic) in Scotland is set at a lower level than the NHS (sic) south of the border. According to the Scottish Parliament Information Centre, the increase in Scotland will be 4.3% in 2001-2003, and 4.4% in 2003-2006, whilst in England the increase is the full 5%. In a reply to SNP Finance Shadow Minister Andrew Wilson, the Information Centre pointed out that, in total, Scotland stands to lose over £500 million through this process. On top of this, the recently announced pay awards for the medical and nursing professions, so cynically timed to coincide with the peak admission period and resultant greatest stress on the service, will have to be funded out of the existing budgets. No extra money has been provided to fund this sudden munificence, which means that Trust managers will have to source the money from other areas of their budget, leading to further cutbacks in the service provided.
The Health Board Trusts must in future be made up of people who are elected to these boards because of pertinent skills in the provision of health care, not appointed as political sops or through the ‘old boy’ network. Too many Health Boards consist mainly of both political appointees and those who have little or no comprehension of patient care provision. No accountant will ever fully understand the medical and nursing department’s requirements, but it is often the case that fiscal arrangements are made with little or no regard to the actual needs of the hospitals. The insane politician-fuelled drive to cut waiting lists at all costs has led, in one Scottish region, to a £12 million budget deficit, which in turn has compromised the standards of care available as the Trust attempt to cut back on costs in other areas. It is currently proposed that a patient suspected of suffering cancer will now no longer be immediately referred directly to an endoscopy clinic by his GP, but instead sent to an out patient clinic to be seen by a consultant, who will then decide on the next phase of treatment. This, in its turn, will drive up waiting lists again and continue the vicious circle. One Scottish cancer treatment centre has waiting times four times longer than the national guidelines. Any increase in waiting time for this type of treatment is potentially a death sentence to some of those on the lists.
Another thorny question must also be asked; does an independent Scotland need Private Health care? Private Health care is a parasitic culture, feeding off the back of the health service, as one way traffic. No private institution trains nurses, doctors or ancillary staff. The burden of cost here is borne by the health service, and no adequate recompense is ever made. A method of ensuring that any private institution pays its dues to society, by whatever means, would go a long way towards redressing the balance. By charging these hospitals a realistic amount for any service provided for them by the Scottish Health Service, up to and including a fee for each and every trained person hired by that company, would also ensure that the resources in personnel were not constantly poached without some financial restitution for the cost of training that person.
Prescription charges need to be examined – is there a place for these, and if so then who are exempt? Obviously pensioners, children of school age and the unemployed must remain exempt if charges apply, but at what level should adult charges be pitched? And is there a case for addressing the problem (again, multinational) of over-inflated drugs charges to the Health Service? The possibility of setting up a factory to manufacture basic pharmaceuticals could be investigated against the background of spiralling treatment costs. This area will be addressed at a later date.
Siol nan Gaidheal does not claim that all of the proposals outlined above will cure every ill in an independent Scotland, but they will contribute to ensuring a long-term improvement in the health of our nation. The short-term ‘fix’ for immediate political gain plays no part in our vision, as it is only by taking the long-term view that Scotland can truly provide for its citizens.
Health Update : March 2000
Additional information leading on from the original article :
Since coming to power, the British Unionist Labour Party has handed over 90 beds in Lanarkshire to BUPA Healthcare Homes, Glasgow Health Board has privatised 180 elderly care beds by handing them over to a BUPA subsidiary, Care First, and the same company has been given 90 beds by Ayrshire Health Board. All this from a party who recently accused the Tories of acting like “the political wing of the private health insurance industry”.
Loss of beds :
The lack of high-dependency units in seven of Scotland’s 58 hospitals has reduced patient’s chances of receiving proper post-surgical care to a lottery, according to Steve Nixon, a consultant surgeon at Edinburgh’s Western General Hospital. He authored a damning report for Scotland’s Royal Colleges, naming the seven hospitals which cannot be counted on to supply high-dependency unit beds. These include Law Hospital, Carluke, and Aberdeen Royal Infirmary. This is at a time when Scotland’s fifteen hospital Trusts are facing a shortfall this year of some 40 million pounds.
Prescription charges :
Prescription charges in Scotland are to rise by 10p from the beginning of April, taking the cost to £6. Susan Deacon, the health minister, stressed that the 1.7 per cent rise did not exceed the rate of inflation. "The Scottish executive has endorsed the UK government’s commitment to restrict the increase in prescription charges to no more than the rate of inflation over the duration of the current Westminster parliament.”
Kay Ullrich, SNP health spokeswoman, said: "It really is an incredible situation when someone prescribed a standard course of antibiotics could take that prescription to the private Ross Hall Hospital and have it filled at a charge of £3, half the Labour government’s new rate for an NHS prescription. Aneurin Bevan must be spinning in his grave."
Andy Carver, research manager of the Scottish Association of Health Councils, said that prescription charges should be scrapped. "The system of collection does not justify the money that it brings in."
Waiting lists :
It is now clear that the British Unionist Labour Party has lied about the reduction in waiting lists. Figures from before the flu crisis, leaked in a Health Service document, show that more than 5,000 patients had been forced to wait longer than BULP waiting list targets allow. This was prior to the flu crisis, which has lengthened waiting lists considerably, as most routine clinics and surgery were postponed. It has also been revealed that coronary bypass operations in Scotland are considerably below the numbers in England and Wales. Currently, only 258 bypass operations are being carried out per million population compared with the English figure of 616 per million.
Professor Lawrence Weaver, the head of Glasgow University’s department of child health at the Royal Hospital for Sick Children (RHSC), led research suggesting up to 16 per cent of children admitted to the hospital are dangerously malnourished. Around 16 per cent of them were found to be underweight for their age, 15 per cent had stunted growth, and 8 per cent showed evidence of muscle wastage. The scale of poverty in Glasgow, where more than 33,000 of the city’s 88,000 children qualify for free school meals, means the city is thought to be suffering most severely. Children from poverty-stricken households run a much greater risk of suffering malnutrition. Their poor diet greatly reduces their chances of fully recovering from potential fatal illness and disease. Children who are malnourished are usually smaller and thinner than the average-sized children, and they can often suffer from anaemia, rotten teeth and constipation. Kay Ullrich, the Scottish National party’s health spokeswoman, said the "disgraceful" figures were an indictment on the present BULP administration’s policy on attacking poverty.
The Health Gap :
Research conducted by Bristol University has found that the "health gap" between Scotland and England has actually grown under the auspices of the British Unionist Labour Party. Professor Danny Dorling found that Shettleston in Glasgow is the unhealthiest area in Britain, housing 20,000 people in grim tenements and suffering a male unemployment rate of almost 40 per cent. Scottish constituencies account for nine of the worst 12 places to live in Britain. The Glasgow constituencies of Shettleston, Springburn, Maryhill, Kelvin, Pollok, Govan and Baillieston have the lowest life expectancies in Britain.
The Organ 'Scandal' - Health Update 14/2/01
The announcement by the Health Minister Susan Deacon (5th February 2001) regarding the 'retention of body parts' scandal that has received so much attention in the Press recently is another typical British Unionist Labour Party knee-jerk reaction to a perceived populist current topic. Whilst this subject has inevitably caused a mass outbreak of simulated 'outrage' in the Press, it has also caused untold heartbreak to the parents of many children whose organs were removed without informed consent and retained. However, there are other aspects to this subject which must be considered.
There has been no Alder Hey situation in Scotland. This outrageous scenario arose from the actions of a single doctor who seemed obsessed with collecting as many organs as possible, and this is not the only place he has done so. I believe that he has questions to answer in Canada, where he worked for a time, and where a similar situation arose. It would be throwing the baby out with the bath water to blanket legislate against the retention of some organ parts following post-mortem examinations, and the aberrant actions of one man should not be used to terminate the practice in perpetuity.
The situation in Scotland is that a total of nearly 6,000 organ parts have been retained over the past 100 years, one third of these in the Glasgow region. This works out at a rate of about 120 organ parts per hospital over a century. Pathologists collect these specimens for several reasons, not the least of which is for the purpose of medical training. All of the main hospitals named in Professor McLean's report in Scotland are teaching hospitals. Several hundred student doctors pass through their doors every year, and anyone with a degree of sense would wish them to be trained to their highest capabilities - after all, at some point, YOUR life may be in their hands! Familiarity with and understanding of the appearance and presentation of various conditions is a pre-requisite to prompt and appropriate treatment of these, and requires more than just notes in a textbook on the subject. The use of organs retained following post-mortems is an essential part of medical training.
Many of these "scavenged" body parts are not held in their entirety. Most undergo a process known as "frozen section", whereby they are (in layman's terms) frozen solid, and have paper-thin sections sliced from them. These are then 'fixed' in a preservative, and placed in glass slides so that they can be studied in the future, by other specialists in the particular field for which they have been retained. This is a normal and accepted part of a pathologist's work, a very useful reference tool, and has been performed for many years.
Many organs or parts thereof were removed to assist in studies of tissue rejection, efficiency of drug therapy, and organ transplantation. No-one can deny that these are areas from which we all may benefit, directly or indirectly, as increasing the sum of medical knowledge. Future research depends upon people being willing to allow parts of their or their loved one's bodies to be studied to see what lessons may be learned, and hopefully implemented, in order that other lives may be saved or improved. This, again, is an essential element in the advance of medical knowledge.
Informed consent for such a procedure is the area that needs most attention focussed on it. The removal and retention of an organ for future study must be conditional on the need for such study. If a small frozen section is all that is required, this can be done rapidly, and the remainder of the organ returned to the corpse, to be disposed of according to the wishes and religious beliefs of the donor and relatives. Doctors also require increased focus in training on the tactful and sympathetic handling of what is a very emotive issue, at a time when relatives are extremely vulnerable. It remains a fact that medical science cannot advance without continuous research and study, and the retention of some organ parts is essential to this. The legislative changes to be made are in the consent process, and in the education of the public to accept that without this, advances in medical treatment must, of necessity, slow down or cease.
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