Today’s Hootsmon prints an op ed piece by local MSP Iain Gray entitled “Smiling and Nodding Will not Create Change”. In it, Iain, a former Minister for Social Justice, fulminates about the lack of progress in harmonising (if not actually integrating) the NHS with social work across the country. Now, I believe Iain may be sincere in his wish to see this but his track record while he was capable of influencing this gives these recent comments more than a whiff of sanctimony.
He is correct in his assertion that the two services ought to work together far more closely and he is also correct that officials on both sides of the divide have not fallen over themselves to make that happen. But if he indeed started this process in 2001, how come, when I became East Lothian Council leader in 2007 and started down the road he advocates, was it as if this idea of joint working had never occurred to anyone before?
There are definitely culpable officials on both sides of the divide. But in East Lothian Council, we rid ourselves of both the relevant director and head of service and set to making joint working the order of the day for the best reason in the world—because it made sense. What we had not bargained for was the degree of entrenched self-interest of senior staff within NHS Lothian.
That first summer, we came up with three major projects that we thought exemplified the joined-up thinking required that would provide better service at less cost to the public purse. The first was a joint surgery and day centre for Gullane. The current NHS Cusworth surgery there is bursting at the seams and the present ELC-run Day Centre requires a substantial re-build.
Looking around for alternatives, we hit on the local tennis courts. They were bang in the centre of the village and in desperate need of a refurb themselves (the chain-link fence round the courts fell over in high winds). By shifting the three courts bodily westward and buying an adjacent house that was on the market, we could plunk a joint building with more than enough car parking on Hamilton Road. Meetings with the surgery doctors, the tennis club, day centre attendees and the public secured local agreement.
NHS Officials attended the same meetings and pledged to co-operate. Four and a half years later, the council has bought the relevant house and shifted/refurbed the tennis courts. But we waited so long for the NHS to commit any capital that it’s been turned over to the Scottish Government to finish. So much for what had been agreed to be a pilot of co-operation. Similar intransigence put two other crucial projects on ice.
They were for a revolutionary concept in local hospital and elderly care. Instead of the NHS ‘rationalising’ its hospitals further away from the patients and the council providing ‘pure’ care homes, why not combine the two? Building 60-bed joint units could allow elderly in care who needed medical assistance to stay in the same room but switch to medical staff—and then back to the care staff when treatment succeeded. There would be no barriers between the two levels of care, the patient would suffer no disruption and the economies of scale would benefit all.
Tranent and Musselburgh were earmarked as likely projects. For four years, ELC tried to get NHS Lothian to commit to this even bigger ‘everyone wins’ concept. We have now given up and gone back to planning for separate care homes while the NHS touts a ‘community’ hospital in Haddington for all East Lothian—as if the other five towns think of Haddington as any part of their community when it’s a 45-minute bus ride away.
Is there a villain to this piece? Why, yes—and it’s not Iain Gray, who may well have tried to shift the NHS off its complacent arse. But he is complicit, because it was on his watch that Professor James Barbour OBE was appointed chair of the board of NHS Lothian in 2001 . Having seen how senior officials operate around Prof. Barbour and having had the depressing experience of sitting across the table from him in negotiations, I would say, simplistic as it is to blame any individual, that here lay the root of willful, pathological obfuscation from the NHS.
What his real motivations for this were remains unclear. Perhaps he, like many other senior Humphreys of officialdom, was angling for a knighthood. But it was clear that nobody in NHS Lothian went to the toilet without his permission, far less work on a project costing millions where anyone else had a say. The only time I recall ELC getting any concession out of him during negotiations, I watched him, as he was leaving, kick a stone clear across the Deaconess House car park in frustration.
But he is not alone. Where Iain and his colleagues must bear much blame was the series of apparatchik appointments they made to the many quangos under their control over their eight years of tenure. While the NHS Boards may not provide the worst examples of cronyism indulged in, it would be hard to find a more egregious example of my-trainset-and-I’ll-play-with-it-as-I-like than Lothian NHS under Professor Barbour.
Iain may be sincere in wishing it were not so but he’s also being very disingenuous.