The Baltic News: 7
Scotland's inequalities shame; the need for cooperation on gender; a story about nationalism
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A badge of shame
THIS last week provided a perfect example of what’s wrong with Scottish politics. An avoidable row over the Gender Recognition Bill saw us take another spin around our no-exit constitutional roundabout. This distracted us from the re-emergence of a vast social scandal which, despite being known about and recognised for years, keeps on getting worse and worse.
I’m referring to the question of Scotland’s health inequalities.
For as the (choose one of the following) dispute over gender legislation/naked assault on Scottish democracy played out this week, two reports were published which put a fresh light on the gap between rich and poor in Scotland. We already know a lot about it but the new papers reveal its depth.
Firstly, the Health Foundation released a major study which in essence showed that the most deprived 10% local areas in Scotland have been cast adrift from the rest of society. If you live in one of these areas, you will on average enjoy 24 fewer years of healthy life than if you live in one of the wealthiest parts of Scotland. You will die 13 years younger. You are 18 times more likely to die of a drug related death. These figures are getting worse. As a country we are essentially choosing to dig moats around these areas and leave the people in them to die early. To compare, Scotland is witnessing the kind of health gaps that exist between people living in banker-rich Kensington and those who died up the road in Grenfell tower.
And then secondly, to analyse the consequences, we released a report which sought to examine the impact on the NHS. Using public health data, analyst Andrew Mooney found that those same people in the poorest parts of Scotland are 72% more likely to require an emergency bed than people in the wealthiest areas. This, Andrew concluded, is because of the effects of poverty and the lack of access to early and effective healthcare and support in their communities. Together with our failure to provide enough social care, this is why acute care is on its knees this winter. We recommended more support for GPs in deprived areas and greater joint working across the UK.
Of course, in Scotland, this is the point at which we usually retreat to our constitutional trenches and work out how to blame the other side. For the record, the Health Foundation makes clear that the UK wide austerity has without question cut incomes and harmed public services, both of which have impacted the poorest the hardest over the last decade.
This was also a message rammed home with some force by Sir Michael Marmot, the globally acclaimed health academic in an event with Gordon Brown in Kirkcaldy on Wednesday evening. You can watch his visible anger over the crisis in a clip here.
But just because Scotland’s constitutional warriors demand that one side must be guilty of all sin and the other innocent of all charges doesn’t mean the rest of us are required to follow them down the path to facile simplicities.
For, as the Health Foundation report concludes, the wider headwinds do not mean that Scotland’s government is prevented from actually getting off its arse and doing something for once.
Or, as it puts it more elegantly: “The broader economic and fiscal context does not excuse the persistent implementation gap in Scotland – between policy intent, delivery and people’s experiences.”
Indeed, it argues, this implementation gap is perhaps the main cause of Scotland’s appalling record.
We have a lot of strategies and frameworks, the Health Foundation notes. Government Ministers all nod that the best way to improve health act is to move upstream, fund preventative action, and deal with the causes of ill health and early death rates.
But there is a consistent failure to put that into meaningful action. The Health Foundation carried out interviews with ‘stakeholders’ on why implementation doesn’t happen. They blamed “short-termism, over-centralisation, a failure to prioritise and a perceived lack of trust between different actors in the system.”
(If you want a superb analysis of this, read Helen Puttick’s piece in today’s Times on the way Nicola Sturgeon’s administration tries to stifle genuine debate and discussion about change within the NHS)
Behind this, it adds, lie bigger factors.
“Political progress in moving towards more mature governance structures, institutions and shaping a more progressive society in Scotland has stalled in recent years. This reflects a combination of political inertia – related to the fallout from Brexit and renewed focus on independence – and a series of crises: weak economic growth post-2008, the pandemic and cost-of-living crisis.”
That paragraph, for me at any rate, sums it up perfectly. Yes, governments are right to say that Covid and The Crunch have made things much harder. But getting distracted and waylaid by Brexit and independence has not exactly helped either.
We’ve known for ages now about the need to change the way we deliver public services if we want to bring about better health outcomes. The fact we haven’t – and the fact those outcomes are getting worse – is a badge of shame.
Gender wars
Not to get sucked back into gender dispute but the stand off we now find ourselves does make the case for another look at the relationship between the Scottish and UK Parliaments. That’s if you agree that Westminster using its power under the Scotland Act to halt Scottish legislation after it has been passed by the devolved parliament is not exactly an optimal way for us to proceed given the opportunity it provides for political chicanery.
Why wasn’t there a more cooperative approach to this matter? The Equality and Human Rights Commission warned in advance that the Gender Recognition Bill would have an impact on UK wide Equality laws. It wrote to both Governments in October last year to urge them to work together to minimise the risk of uncertainty before the legislation went ahead. Did that happen? Lord McConnell, the former First Minister, has now asked for all minutes of those meetings to be published.
Clearly, even if they did take place, they didn’t get anywhere – and we’ve now ended up in a constitutional bunfight. It's another example of how ad hoc arrangements governing the relationship between the devolved and UK parliaments are simply not strong enough to handle a situation in which one or both parties don’t want to play ball.
I see my good pal, the Conservative MSP Donald Cameron, is going to look at reforms of the Scottish Parliament’s procedures. Is this something he might look at?
Nationalism is small
Finally, back to Kirkcaldy and Sir Michael Marmot’s discussion on the health gap earlier this week. Half way through the event, Sir Michael berated the fact that, since Brexit, there had been no fewer than five Health Secretaries in Westminster. This was hardly conducive to effective government he noted. At this point he got heckled by a lady wearing a SNP lanyard. “Not in Scotland, we’ve only had one!” she shouted.
She was wrong, as she was later reminded (there have been three: Shona Robison, Jeane Freeman and Humza Yousaf). But that isn’t really the point. The point is that this is what happens to political debate when it’s corroded by nationalism. Here was the world’s leading academic on the subject of health inequalities putting his mind to how we can answer the complex questions it raises. And here those questions were being reduced to “how can I show we are slightly less bad than England?” And “by what largely meaningless metric can I prove this?”
It's important to say that supporting independence for Scotland does not require you to be a nationalist. All the same, it would be nice to hear less of the nationalist case being made for it. Because it’s really not a very good case at all.
ENDS