Saturday, 20 January 2018

Decisions, decisions, decisions.

I want to  start by saying something that might surprise you. I am in favour of the decision to close Ward 15 (the Children's Ward) at the Royal Alexandra Hospital in Paisley.

And here is why.

The standard of hospital medical treatment is not, can never be, the same across the whole of the NHS. It depends on the number and qualification of the medical staff available and inevitably in busier metropolitan areas these staff are more numerous and the possibility of sub-specialism much more readily available. The larger the unit therefor the greater the level of expertise and experience available and with that the greater the prospect of expeditious and successful treatment.

Further, the quality of all medical professionals is not the same and inevitably the very best are inclined to be attracted to where they will enjoy the greatest variety of medical experience. Again creating a virtuous circle where the best treatment is inclined to be in the larger hospitals.

Further still, the constant interaction between the university based medical schools and the hospital sector makes working in a hospital near to such a university a much more attractive proposition for those providing teaching as well as treatment, as well as for those still engaged in professional development.

And finally, when it comes to the quality of life, working with more colleagues and being able to draw on their expertise is in itself a significant stress reducer. Not to mention the greater flexibility likely to be available when wanting a holiday. But, outwith work, basing yourself where you can work until 6.30 and still get to the opera or the theatre is a consideration all of its own. So if you are at the top of the profession, with skills in demand and the opportunity to make a choice then the choice is obvious.

Thus, as a general rule, medical expertise is greater and treatment likely to be superior in the cities.

At the back of our minds we all recognise that but we also recognise that in where we are treated the system makes a trade for our own convenience. If hospitalised we might, indeed often do, prefer to be treated where we can easily be visited by friends and family and readily and easily get back home when our treatment is concluded. That's why not all hospitals are in the cities, even in urban Scotland.

But of course that's not always possible. Some illnesses or conditions are sufficiently complex but relatively rare to preclude the maintenance of local expertise and to require the creation of National or regional specialist units to which, like it or lump it, the patient requires to travel.

And it is not at all unreasonable to class children sufficiently ill as to require hospitalisation as falling into that rare or complex category. Particularly as the hospital to which Paisley's juvenile patients will now be referred, The Royal Hospital for Children in Govan, Glasgow, is, frankly, no great distance from Paisley and indeed for patients from the north and east of the town, if not nearer as the crow flies then certainly quicker to get to at certain times of the day when otherwise you would require to negotiate the centre of Paisley.

And the geography is hardly unprecedented. It is eight miles from my home town, Paisley, to the hospital. My new home, Kilsyth, hardly in the middle of nowhere, is twelve miles from our nearest general hospital, Monklands, without anybody locally being noticeably outraged by that. Our nearest Lanarkshire Health Board children's ward is in Wishaw!

So why all the fuss?

Because the decision making over the RAH is indicative of something much more concerning in Scottish public life under the SNP, an unwillingness to be honest with the electorate. To be honest about difficult decisions for fear of offending.......somebody. "Rumours" about the possibility of the ward closing have been circulating for more than two years but the response of the SNP until yesterday, not just locally but in a now notorious television appearance by the First Minister herself,  has been simply to deny the very possibility. Accusing opposition politicians raising concerns of, using that all purpose nationalist response, "scaremongering".

The problem for them is that this is a strategy that eventually falls foul of time. The outrage over the closure will inevitably be much greater now than if an honest case had been made for it earlier in much the manner described above by..........me. As it is going to be over a similar exercise still going on over the eventual permanent closure of the children's ward at St John's Hospital in Livingston.

But this is only indicative of a wider stasis in our devolved public services. Consider education. There is a widespread acceptance that something needs to be done but doing anything will inevitably upset somebody, I suspect indeed a good deal more somebodies than the local Paisley campaigners. So the response has been little more than the wringing of hands.

Take fracking. They could pass legislation blocking this permanently but in doing so cause significant damage to the Scottish economy possibly paving the way for the departure of our biggest single site employer. Or they could allow it, outraging their more luddite supporters and perhaps even causing discrete noises of disapproval from their not quite totally owned minor Party allies. So instead they have announced a permanent moratorium clearly in the hope that the judicial review now launched by Ineos will get them off a hook of their own creation.

Or taxation. They could stick with UK levels ("while we remain without the full levers") on a point of principle or they could raise taxes to sufficient effect as to provide meaningful additional public spending. Instead they've done neither. Bringing in negligible additional income (less than £200 million against expenditure of more than £32 billion) with tinkering aimed at little more than making us "different" from England.

Why this timidity on all these fronts and, perhaps most appallingly, on the example I conclude with?

Because the SNP are in reality two things at once. Certainly they are the government of Scotland but they are also a permanent campaign for Scottish Independence. And that latter function depends on the maintenance, indeed the expansion, of the fragile "Yes coalition" that has got them (to their mind at least) close to their ultimate goal. But the danger of alienating anybody as a supporter of the SNP is that you also offend them as a supporter of independence. And decisions of any sort inevitably offend somebody.

Yet sometimes decisions have to be made as they ultimately had to be made over the RAH children's ward. As they will ultimately have to made over education and the other examples I provide. And ignoring that inevitability only makes the ultimate climb down all the more offending.

As I said I will finish with one particularly outrageous example.

On 3rd May 2015, a man called Sheku Bayoh died while being restrained by police officers in Kirkcaldy. Now, as I said above, the Yes coalition is a wide one. It includes on one wing many who are of a naturally anti authoritarian bent with little time for the "forces of state repression" in any form. But it also extends well into the leadership of the Scottish Police Federation, who have come repeatedly to the nationalists assistance, from during the referendum when they claimed to have seen little or no evidence of nationalist thuggery, to more recent support over the handling of the leadership crisis at Police Scotland.

But the problem over the Bayoh case is that, whenever a decision is made on whether there should be prosecutions, one or other group is going to be furious, "offended". For the former can see no circumstance in which a black man might die accidentally while in police custody while the latter no circumstance in which Police officers might ever be heavy handed in dealing with any suspect (at least unless they had brought it on themselves).

So, the nationalist answer to this conundrum? Nearly three years after Mr Bayoh's death, eighteen months after a report was submitted to Crown Office, no decision has been made either way whether to prosecute or to rule out prosecutions.

Now the actual decision is of course a matter for the independent prosecution service but demanding that they make a decision is surely a matter within the remit of the Justice Minister's responsibility to protect the integrity of the system? Except of course, no decision offends nobody. And perhaps offending nobody matters more than any other consideration.

I'd only point this out as a statement of the bloody obvious. A decision of some sort will have to made sometime and that's highly unlikely to be after a "second referendum", even on the most optimistic of nationalist timetables.

Perhaps it's time for them to realise that, to paraphrase Lincoln, "You can't please all of the people, all of the time" and just get on with it. Indeed get on with deciding things more generally.



4 comments:

  1. Very similar arguments were valid when Labour proposed closure of A and E at Ayr. If you cannot carry public with you you are in real difficulty. Also a mature political party allows its local representatives to take stand apart from the party line on sensitive local issues. When SNP reversed decision Nicola said public opinion must take precedence over professional judgement- that’s the hypocrisy in this. Also their local MP and MSP have shown that they lack political maturity in how to handle an issue like this

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