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Will a spoonful of Freeman help the waiting times go down?

Sarah Nimmo

Although the nanny with the magic bag would have us believe that “in every job that must be done, there is an element of fun”, it seems unlikely Scotland’s new Cabinet Secretary for Health & Sport, Jeane Freeman, has an easy road ahead.

Widely praised for the progress she made in establishing Scotland’s new social security system, Jeane Freeman now faces a job that will include dealing with a myriad of missed targets, delivering on delayed strategies and sorting out a “workforce crisis”.

Supported by Joe FitzPatrick and Clare Haughey, Jeane Freeman will do well if she manages to dampen down the frequent accusations from opposition parties that NHS staff are overworked and undervalued, while services are unable to deal with a range of pressing public health crises. During Shona Robison’s tenure, opposition parties settled into a routine of issuing damning indictments over missed targets, including for A&E waiting times (which have not been met since 2015) cancer treatment times and stroke care. A recent Nuffield Trust report concluded the NHS, when compared with other health services in similar developed countries, performs worse than average in the treatment of eight out of the 12 most common causes of death. Relatedly, analysis carried out by the BBC recently found Scotland had the “highest avoidable death rate” of any nation in the UK. The new Cabinet Secretary therefore comes to office as fierce criticism is aimed at the Government, including assertions that Scotland is being gripped by a “drugs death crisis” and doctors are being “pushed to the brink” by staff and resource shortages.

Where to begin?

It is not too long since the Scottish Government published its Public Health Priorities, in partnership with COSLA, to reduce the social and economic impact of ill-health and inequality. Opposition parties will no doubt be hoping such promises prove to be more than pie crust (a reference for the more dedicated Poppins fans among you) and able to deliver “real change”.

July brought with it a response to repeated declarations that Scotland’s obesity levels constitute a “public health crisis”. The long-awaited publication of the Diet & Healthy Weight Delivery Plan was swiftly followed by the Active Scotland Delivery Plan. Next month, the Cabinet Secretary may well be hoping for a more significant increase in physical activity levels after this summer’s European Championships, being hosted in Glasgow, after surveys concluded the 2014 Commonwealth Games did little to increase participation. The delivery plans had a mixed reception, with the WHO stating the Government was leading on “putting policy commitments into concrete actions”. Opposition parties disagreed, however, as the Liberal Democrats reacted with calls for a falls strategy to tackle inactivity and isolation among older adults, and the Greens queried why an active nation commissioner had not yet been appointed. Pressure is also beginning to build as we await publication of a Good Food Nation Bill, a development some hope will do more to limit industry-led promotion of unhealthy food and drink.

Following the introduction of minimum unit pricing, efforts to tackle harmful alcohol consumption are likely to remain high on the agenda. The Government said its renewed alcohol strategy will be published in the autumn. The NHS Health Scotland MESAS monitoring report for 2018 found Scots consumed enough alcohol to surpass weekly guidelines by 40% every week of the year and that alcohol-related hospital admissions were four times higher than they were in the 1980s. Hopes will be high for minimum pricing to deliver the change promised by its supporters.

Workforce issues have dogged health and social care services in recent times, and will no doubt be a top priority of the new Cabinet Secretary. Recent announcements include the expansion of NHS recruitment following a relaxation of visa regulations, and a 9% pay rise for some NHS staff. Significant improvements will have to be made to ward off Labour’s frequent accusations that NHS staff are overworked and undervalued. Reactions to cancer treatment times and emergency department waiting times are representative of growing concerns about wider workforce and resourcing issues. Both the Conservatives and Labour have branded failures to meet cancer targets a national scandal and the result of years of mismanagement by the current Government. If Jeane Freeman manages to meet some of these targets early in her tenure she will be in for high praise, or at least some respite from a frustrated and unsatisfied opposition.

In collaboration with her Minister for Mental Health, we should expect action to improve mental health in Scotland. The Scottish Government’s publication of an audit of rejected referrals from CAMHS highlighted dissatisfaction with the volume of rejections and inadequate signposting, while the Liberal Democrats and others branded the Government as “negligent” for not providing an updated suicide prevention plan.

Looking ahead to when Parliament resumes, the anticipated work programme of the Health & Sport Committee will provide some opportunities for scrutiny of the Cabinet Secretary’s performance in several areas. The Health and Care (Staffing) (Scotland) Bill will undergo Stage 1 scrutiny by the Committee, while consideration of the health and sport budget allocation is expected alongside continued scrutiny of health boards’ performance, the implementation of the preventative agenda and, of course, the implications of Brexit.

Recently commended for her efforts to avoid any replication in Scotland of the pitfalls that have troubled the roll-out of Universal Credit elsewhere in the UK, it remains to be seen if Jeane Freeman will achieve what her predecessors could not with regards to Scotland’s health service. Only time (and statistical publications) will tell whether the Cabinet Secretary turns out to be just what the doctor ordered.

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