Scottish Government health spending

A few months ago, Audit Scotland released a report on the funding of NHS Scotland which rightly received significant press coverage.  The headline finding was the SNP are reducing the health budget in real terms by 0.9% between 2013/14 and 2015/16.

Understandably, opposition parties tried to make as much as they could of this revelation, highlighting the contradiction between the statistics and the SNP’s rhetoric of “protecting NHS budgets” – something which I have covered on this blog previously.

Just as understandably, the SNP sought to “manage the story” by giving “their side of the story” and attempting to justify the statistics.  In this case, it fell to Health Secretary Shona Robison:

The Audit Scotland report outlines that the NHS revenue budget – frontline spending – has increased in line with this Government’s commitment. The capital budget meanwhile fluctuates from year to year depending on on-going capital infrastructure projects. The reduction in 2015/16 is largely due to the completion of the new Queen Elizabeth University Hospital in Glasgow, which was funded from the capital budget.

http://news.scotland.gov.uk/News/Response-to-Audit-Scotland-s-NHS-in-Scotland-2015-report-1e83.aspx

There’s nothing unusual or even anything particularly wrong in any of this, it’s fairly standard politics.  A negative story is released and the subjects of that story attempt to mitigate its impact.

Of course the government’s response doesn’t actually answer the conclusions of the Audit Scotland report, it doesn’t even try to.  Instead it tries to do just enough to give their supporters a nice line with which to refute the accusations, something that can be easily remembered and easily repeated.

As is so often the case, the government’s line is then parroted and embellished by collusive online supporters – in this case here and here from Wings.  These help to get the government’s message out there, cementing the consistency of the rhetoric and ensuring that any use of the “Scottish Government cut health spending” line can be quickly undermined.

Even months after the report was issued, this tiresome pattern is still being repeated – as you can see with the comments responses to this Herald letters’ page.

There is nothing factually inaccurate in any of these arguments.  The SNP *is* cutting the overall health budget by 0.9% in real terms by 2015/16 and this is primarily caused by a 53.6% cut to the capital budget whilst the revenue budget is *increasing* over the same period by almost 1%.  These facts are clear from the Audit Scotland report.

But they don’t tell the whole story.  Revenue budget, the money that is spent on every day front-line services, might be seeing a real-terms ~1% increase but this is less than the corresponding increase in the NHS south of the border.  The spending on NHS England, which dictates the Barnett consequentials that are added to the Scottish Government’s block grant, has increased and continues to increase by a greater proportion than Scottish NHS spending – and this is not an isolated finding, even before the general election the IFS had reported the same thing.

IFS figures
Figure 1 – IFS Report

And this while the overall budget in England has been cut by 55% more than Scotland’s.

The Scottish Government’s half-truth that this reduction is merely because of the completed Queen Elizabeth “super hospital” in Glasgow doesn’t stack up either.  For a start, why does the completion of one large project prevent the now freed-up cash from being spent on a new project?  Instead of re-allocating that money into improving infrastructure, the SNP government decided to use it elsewhere.

Capital investment is important, something the Scottish Government are keen to laud when they’re spending the money; patting themselves on the back for infrastructure which will provide “increased efficiency, shorter waiting times and better continuity of care“.  Why are these goals suddenly unimportant when they cut the capital spend?

The same Audit Scotland report which details the spending cut also makes clear just how important *continuing* capital investment is:

Capital investment is important in enabling boards to plan and deliver the 2020 Vision, by investing in new healthcare facilities, maintaining and modernising existing facilities that will be required in future, and disposing of those that are no longer needed…

The annual financial targets for capital budgets, and uncertainty about future budgets, hinders NHS boards’ effective planning of capital projects…

The NHS needs the right buildings and facilities to achieve the 2020 Vision and provide healthcare that meets future needs.

How the completion of one hospital in Glasgow suddenly became an accepted excuse for a capital spending cut of over 50% is beyond me.

Meanwhile yes, Scottish NHS revenue budgets have increased but, again, nowhere near in line with the NHS south of the border.

health budgets
Figure 2 – see sourcing at bottom of the article

So whilst the Scottish Government is technically correct that they have increased revenue budgets in real terms, they have done so at a level which lags pitifully behind the increases from the coalition and Tory governments in England.

The usual response to this is that the Scottish Government’s budget is being cut, invariably referred to as Westminster austerity, and that budgetary constraints are being forced upon Scotland.  This is the predictably tiresome excuse Stuart Campbell uses in the first Wings article linked above – complaining that “Holyrood’s total budget has fallen 10%” and “under exceptionally tough circumstances the Scottish Government has worked miracles in defending the NHS”.

Referring to a 10% cut, Stuart can only mean the Scottish Government’s DEL in comparison to the 2010 figures, which begs two questions:

  1. Why are we supposed to consider DEL cuts since 2010 as an excuse for a health spending cut since 2013?
  2. If the Scottish Government has “worked miracles” then what superlative would Stuart use to describe the Tory / LibDem coalition which far exceeded Holyrood’s NHS spending record whilst facing 55% deeper cuts?

Of course, there’s a good reason that nationalists always want to refer to budgetary changes since 2010.

Real terms DEL

 

Perhaps a debate for another time but the SNP always use 2010 as the benchmark because it was the high-point of Labour’s pre-election spending and saw record DEL delivered to Holyrood, meaning that stats using “cumulative cuts since 2010” are conveniently eye-watering.

Surely it would be more appropriate to compare health budgets since 2013/14 with DEL since 2013/14?  And when we do that, we see that the Scottish Government DEL is actually increasing, in real terms, by 0.7% for 2015/16 (see note 1 below).

So not a 10% cut and it’s worth noting that the Scottish Government aren’t projecting a 10% “cumulative cut since 2010” to become reality until at least 2016/17 whilst a comparison with the DEL in 2007, when the SNP came to power, would reveal a cumulative real-terms cut so far of just 2.2%, slightly more than the 2.1% drop in Scottish GDP but well below the 10% real terms drop in Scottish tax revenue in the same period .  But now we’re just playing with figures which, ironically, is exactly what the Scottish Government and Wings have done in trying to deflect from the negative results of the Audit Scotland report.

It can simply no longer be denied that the SNP Government has chosen to cut health spending; nor can it be denied that whilst the revenue budget has increased marginally in real terms, it has not done so at the same rate as NHS England.

I’m sick of saying this but that is the Scottish Government’s prerogative, it is their choice and no-one else’s to assign their budget in this way.  There may be very good reasons to re-direct that money elsewhere.  Perhaps a voter would prefer a government that has spent their taxes on subsidising the council tax freeze or providing free university tuition to students from high-earning families but it should be acknowledged that it is the Scottish Government’s conscious decision to do so and a choice which leaves a serious funding shortage in our health service.

pressures

The very first conclusion in the opening page of the Audit Scotland report highlights the ongoing financial pressure that our NHS is subjected to.  Pressures which will continue to increase as we face the inevitable impact on an aging population that is living for longer with more complex and more expensive chronic conditions.

We should be discussing these issues and contributory factors such as lifestyle and dwindling sporting participation in all age groups.  We should be discussing mental health and palliative care.  We should be discussing the exponential growth in the cost of medication.  We should be debating what we want from the NHS and whether it can, or even should, continue to be the comprehensive service it has become; and, if so, what it will take to fund this.  We should be honestly discussing the tax implications of that choice and whether we are willing to pay more to ensure the health service’s survival.

In other words, we need exactly the sort of debate that Norman Lamb is leading calls for in England:  a non-partisan cross-party commission into health and social care in England – “a Beveridge Report for the 21st Century”.

I’d like to see the opposition parties in Scotland calling for the very same here.  I’d like to see my own party, the LibDems, lead the way.  I’d like to see Willie Rennie raise this in Holyrood, reference the SNP’s spending record and prove that they have not matched spending increases in England; but use it not just as a stick to beat them with but constructively to pressurise the government to convene a similar commission and not just put up a desperate smokescreen about capital spending.

Whether or not that’s possible in a political environment that is all about the constitution?  I doubt it.

—————————————————————————————————————————————————————————-

Figure 2 – sourcing.  Scottish NHS figures taken from Audit Scotland report page 9.  NHS England statistics for 2013-14 and 2014-15 taken from HM Treasury Country & Regional Analysis 2015 Table A.11.  NHS England statistics for 2015-16 taken from Department of Health Spending Review.  HM Treasury GDP deflators used so that all figures are in 2014/15 values.  Note that the results are different to the IFS report as the budgets have changed in the interim. 

Note 1- the increase here is sourced from the DEL figures given in Tables 1.01 of the 2015/16 Scottish Government draft budget and 2016/17 Scottish Government draft budget.  Using Total DEL figure of £29089m for 2013/14 from the former and Total DEL of £30141m for 2015/16 from the latter; and using HM Treasury GDP deflators (with 1.4% adjustment for 2015/16) adjusts those values to 2014/15 prices of £29505m for 2013/14 and £29725m for 2015/16 – a 0.7% increase.  NB: ScotGov budgets make comparisons using “Total Fiscal DEL” which excludes “non-cash DEL”, “financial transactions” and “capital borrowing limits”.  Excluding these values for the comparison results in a 1.6% reduction from 2013/14.

Note 2 – I should state here that I do not think NHS England is adequately financed either.  It is clear from all the statistics, reports and results achieved south of the border that there is a funding problem for the health service across the UK.  I should also say that there are clearly some successes within NHS Scotland which should not be ignored but anyone claiming that the NHS does not need additional money should perhaps visit one of their establishments at the earliest possible opportunity.

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12 thoughts on “Scottish Government health spending

  1. Here’s the thing, champ: wasting money isN’t a good thing, especially when it’s in short supply. Nobody cares how much money you throw at a problem. People care about the results. And the Scottish NHS is performing extremely well compared to those elsewhere in the UK by most measures. Only in the crazy world of the Unionist does getting better results out of less money translate to SNP BAD.

    Liked by 1 person

    1. Hi Stu, thanks for the comment.

      Of course I agree, it’s results that people care about but I’m not convinced that NHS Scotland is performing better than elsewhere in the UK. The Nuffield Trust report, which seems to be the latest direct comparison I could find, certainly wouldn’t support that suggestion.

      Regardless, though, agreeing as we do that results are what matters to people, there is no doubting that there are still pressures within the NHS and pressures that could be alleviated by additional funding. To suggest that people will be happy to accept “a bit better than England” when it *could* be better still seems like an odd conclusion.

      But well done on getting “SNP Bad” in there.

      Like

      1. I wouldn’t piss on your distorted, cherry-picked and often flat-out lying blogs in they were on fire, love. For all I often disagree strongly and caustically with Fraser, I believe that at the core he cares about trying to get facts straight. You’re a cheap and nasty party hack and smear merchant

        Liked by 1 person

      2. Wings,
        NOBEBODY is fooled by your use of vitriol to distract from the argument. The Nuffield Foundation report (cited in my blog) is authoritative and carries far more weight than my opinion and yours combined.

        Quit apologising for the SNP and start supporting those who want to improve the NHS in Scotland.

        Like

    1. Your come back is “#LabourBad”? Oh dear. Let’s look at what the Nuffield Foundation had to say about the NHS Scotland reforms implemented by Scottish Labour/Lib-Dems:

      “In terms of whether Scotland’s greater emphasis since 2005 on targets and performance management has had an impact, it appears that Scotland’s hospital waiting times now match England’s, suggesting, but not proving, a positive effect.”

      Liked by 1 person

  2. Thanks again, Fraser, for a well thought-through, conscientiously researched and well-put account. You manage to pick a clear way through a forest of the various category definitions & totals, explicating knotty points as you go.

    1) You make plain the various actual sets of figures in play – as against propaganda manoeuvrings – and highlight the use of political excuses, smoke & mirrors employed by those carried away by their own electoral success:

    For a government to be up against it economically speaking, is one thing. To have hard decisions to make – notably through stringent times – is part and parcel of politics and good governance.

    But to hide behind placard-type phrases that claim massive health service cuts are being inflicted on you and the population, to blame external big bullies – within decision areas that are in fact within your financial powers – and use this stealthily to impose hardships of your own making: that is another matter.

    2) Characteristically also, you bring forward your line of argument, and conduct the later discussion, in a way that is fair, reasonable and open to your readers’ judgment. For all the vital, emotive importance of the issues you discuss. Which takes some doing.

    How very different from the typical procedure of Mr Campbell: presenting (shakily-founded) faits accomplis of thinking to anyone who will fervently take his word for it, and believe such hocus-pocus is sound practice.

    And then that compulsive habit of vociferous, untamed, not infrequently rabid abuse whenever his mysterious “authority” is questioned. Stuart forcefully asserts whatever convictions he currently prefers. His approach appears to have the main purpose of reinforcing his own credentials as a Great Guru, thereby eliminating any need for his readers (and generously crowdfunding acolytes) to think it out for themselves. Transparency, with Stu, is a foreign country.

    Returning to the blogpost, Fraser: I’d like to make 3 particular points.

    1) I’m not always sure how general a reader you are addressing. Often a moot point when dealing carefully with economic figures. Just in case you have intelligent laypeople who are not confident in their grasp of the various categories/calculations (and the real significance and impact of stats), might you perhaps make the difference between “revenue budget” and “capital budget” even clearer than you do?

    You do establish the distinction: describing the former as intended to cover ongoing (“day-to-day”) spending. But might you also glass the latter, as covering longer-term planning: the *structural* level? (I’m thinking perhaps of a quick glossary note at the top or end of the blog.) ~ Or maybe I am overdoing the Beginners’ Guide element here!

    2) Am I correct in taking your formulation “Now we’re just playing with figures” to be at least partly sardonic? Since your interpretation of figures is done in the reader’s sight, so to speak – and can thus be argued with. And, as far as I can see, rings true.

    Tongue-in-cheek perhaps, since it IS important to establish a reliable basis of information. There are too many in the present climate who seek to decry, deny, any objective basis for argument, and basis also for justifiable economic, social and political decisions: preferring mystification and blind faith.

    In other words, the adequate presentation and interpretation of figures is also a matter of integrity, and long-term credibility, that is better addressed now than later.

    3) “I’d like to see whether or not …” I particularly like this section of your entry.

    The SNP machine has developed a fondness for portraying all and any criticism of its decisions & behaviour, all holding to scrutiny & account, as somehow subversive. The Party has even invented its own slogan “SNP BAD” to urge its supporters to disqualify any such criticisms: as if these were by definition both in bad faith and injurious to Scotland. Perhaps not surprising, as the SNP indeed HAS accumulated much to answer for – weak performance, inertia, deceptions, and all too often added bad faith – despite its astonishing allergies in accepting the due responsibilities of government. Despite its behavioral patterns of official bluff and truculent statements.

    For all this top-down sabotage of the political process, it is, as you say, also crucial important for others to rise beyond the vicious circle of “mudwrestling” – the winner of such a low standard of politics in any case often being that combatant prepared to stoop lowest, and resort to blinding opponents with toxic mud – and attempt to present a more honest, practically grounded, purposive, and practically better set of possibilities. Raising the offered level of political discourse is also vital for the health of the soul: a certain peace of mind from day to day.

    Your blog entries contribute, in their own modest way, to showing such a way forward out of the current murk.

    Like

  3. I have to add one more set of thoughts. There’s a German saying: “der Ton macht die Musik”. Literally: “It’s the sound (“tone”) that makes the music.”

    A pale equivalent would be: “it’s not what you say, it’s the way you say it.” Pale because content on the one hand, and delivery/method/tone on the other, both count.

    Stuart habitually vindicates his own foul and intemperate outbursts as if these were honest language, natural and deserved (because he feels so angry). I suppose, sooner or later, readers decide whether this self-righteous toxic primitivism holds water.

    The Reverend has lots of form in this regard, with death curses involving chemical fires, tongues ripped from dead non-SNP candidates’ mouths, etc. Some of the latest being towards Kevin Hague after a radio duel, which is not worth repeating. These hysterical outbursts of fury are common, and appear to have marked his discourse since he abandoned the LibDems (and his profession as a gamer), and started crowdfunding his campaign-mongering.

    It’s entirely typical of Stuart (again) that he plays a devious game in the Comments above. In supposedly complimenting Fraser on his honest intentions, in order to turn on Scott Arthur with what is then presumably calculated to appear to his believers as fair-minded and entirely justified vitriol, he is only playing another opportunistic game, the old “divide and rule”.

    To describe his approach towards Fraser as e.g. “caustic” is in fact a mighty euphemism. Back in November, his approach to the holder of this blog was:

    “I have very little tolerance indeed for liars, the stupid or those who feign stupidity in an attempt to mislead, and I use language for its intended purpose, which is to express and articulate those feelings. If I call you a fucking idiot it’s because I mean to say precisely that, because merely “idiot” does not adequately convey my contempt.”

    Whose is the bad faith?

    Like

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