UNISON criticises report on 'crude productivity' in NHS Scotland

21 January 2010

Comments by John Gallacher, Secretary of Health Committee
on report 'Comparing NHS performance in the UK' from Nuffield Trust

UNISON is very concerned that a report which even its authors admit uses ‘crude productivity’ statistics and fails to measure key outcomes for patients, is seriously being recommended as a basis either for measuring how Scotland addresses poor health, or for challenging health care funding across the UK. The fact that the same authors propose a further study of NHS funding across the four nations of the UK raises concerns that they are trying to challenge much needed public service resources from a partial, slanted analysis that fails to deal with fundamental problems or tell us what the outcomes are for patients.

In addition the considerable emphasis that is devoted to attacking devolved governance of the health service leads one to suspect that there is a wider political motive behind this research than purely investigating differences in the delivery of healthcare. Do they have a vested interest in maintaining the ‘purchaser-provider’ split or financial assessments of NHS performance that are common in England?

Problems
The analysis seems to suggest that despite increased funding (since devolution) to NHS Scotland, our health record is poor. This is at best failing to grasp the main point about health, at worst getting cause and effect the wrong way round. In fact funding on the NHS deals with the consequences of poor health, not the causes. Scotland’s poor health record predates devolution and will only be tackled by tackling the causes of poor health – economic, social and environmental problems. Reductions in general public spending will only exacerbate these causes – whatever the spend on the NHS is.

The statistics of lower levels of patient treatment per nurse/doctor/GP etc. simply measure the numbers of patients being dealt with in hospitals and surgeries. They take little or no account of the overall patient outcomes (This is despite the report acknowledging that the aim of the NHS in Scotland is to ‘improve quality of care along the patient pathway’) or the number of patients being treated at home or in the community. Indeed the ‘Shifting the Balance of Care’ initiative is aimed specifically at improving health by increasingly emphasising health improvement and anticipatory care.

Neither does the report take into account the major geographical differences that exist in highland and island Scotland compared to most of the rest of the UK – Highland Council covers an area the size of Belgium, but has a population the size of Milton Keynes. It is inevitable that higher numbers of healthcare staff per head of population will be required to provide an adequate service for this large rural area that has no direct comparison elsewhere in the UK.

The statistics are also taken from old figures (3 years old at the most up-to-date).

There appears to be no reference to the monitoring and accountability that does exist in Scotland. Robust financial performance measures are applied in NHS Scotland, including direct accountability of Chief Executives and Board Chairs to the Minister – via public meetings. NHS Scotland has had good success in contributing to Scottish Government efficiency targets.

But the real concern about this report is that the authors seem neither to understand nor to accept what devolution means.

They are horrified that the Treasury ‘cannot hold devolved governments to account for their performance through targets’. And they do not seem aware that devolution means that:
a) the accountability of the NHS in Scotland is to the Scottish Government – not to the Treasury,
b) the accountability of the Scottish Government is to the Scottish people represented in the Scottish Parliament, and
c) this means that decisions on the NHS in Scotland and how its outcomes are monitored will be taken by accountable government in Scotland - NOT by regulatory quangos or government departments in London.

UK taxpayers do NOT “have a right to know how well the different governments are, or are not, securing value for their money” – the relevant national taxpayers do.

They (the authors) really ought to get out more!

For further information see:
Row breaks out over report on Scottish NHS - The Herald, 21 Jan 2010
20 Jan: UNISON rejects report on 'crude productivity' in NHS
Comparing NHS performance in the UK - Nuffield Trust, 20 Jan 2010