An overwhelming case can be made for a cull of the many NHS boards in Scotland. A population of about five million does not need over 20 bodies in the health service, many with overlapping remits.
Duplication is rife and the amount of cash spent on chief executives and other senior staff could be diverted elsewhere. If John Swinney decides to consolidate the number of boards and reform the NHS in this way, he will have our support.
Need for greater accountability
But reducing health boards should not be the only objective of overhauling the NHS. Transparency and openness have been lacking and there is a huge need for greater accountability.
The scandal of child cancer patients dying over water-related infections at the Queen Elizabeth University Hospital in Glasgow is a national disgrace. NHS Greater Glasgow and Clyde refused to accept responsibility until the end of a public inquiry.
During this period, parents were cruelly gaslit and told their concerns were unfounded. At NHS Tayside, patients also feel betrayed over the scandal of the disgraced brain surgeon Sam Eljamel.
Public sector shake-up
How he managed to continue working at Ninewells Hospital in Dundee when he did so much damage to vulnerable patients is breathtaking. Another public inquiry – again costing shedloads of public money – will hopefully get to the bottom of this fiasco.
The Sandie Peggie tribunal case in Fife, and the various scandals in NHS Lothian, further undermined public confidence in these boards. But public service reform should not be confined to the NHS.
We have more than 100 public bodies in Scotland spending ever-increasing amounts of taxpayers’ money. Whether they are quangos or government agencies, these bodies accumulate staff while their outcomes do not improve.
Reasons for reform
It is also worth asking if Scotland still needs 32 councils. The current structure of local government came about through Tory gerrymandering in the 1990s.
This model was tainted from the off and looks unwieldy decades on. There are two primary reasons for a fundamental shake-up of the public sector more broadly.
One, the government is facing a £4.7 billion black hole by 2030 and every pound has to be well spent. Two, saving money by stripping out waste could free up resources for frontline services.
It could result in more doctors and nurses being hired, or fund a tax cut for working and middle-class Scots. It is ironic that Swinney is preparing to downsize a state largely created by the SNP government.
But he has a mandate to govern for five years and an opportunity to push through bold change. The First Minister should remain focused on the task of bringing the public sector into the 21st century.
