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Johnstone's View 15th January 2010

David Cameron this week launched the Conservative Party's draft health manifesto. This is the culmination of three years of work in which he has consistently made the NHS his priority and during which, as political parties compete with each other to threaten draconian cuts in public expenditure, he alone has held firm that the NHS budget will be protected. He has consistently fought to protect the values the NHS stands for and has campaigned to defend the NHS from cuts and reorganisations.

I remember the irony some years ago when the Labour Party were celebrating the 50th anniversary of the creation of the NHS, while conveniently turning a blind eye to the fact that, of these 50 years, all but 15 had passed under a Conservative government and that, during the limited tenure of Labour, in the late 1970's, the service was brought to its knees by, of all things, a fight between a Labour Prime Minister and the trade union movement. As the facts bare out, the Conservatives are the party of the NHS and committed to the idea at its heart – that healthcare in this country is free at the point of use and available to everyone based on need, not ability to pay. Labour promised to save the NHS but today, despite the massive increase in spending, the gap in health outcomes between the UK and the rest of Europe has actually widened.

Here in Scotland, control and responsibility for the NHS is devolved and lies with the government in Edinburgh. Nevertheless, as it has in England and Wales, the service has suffered a decade in which top-down bureaucratic mismanagement has consistently undermined the professionalism and motivation of NHS staff and skewed NHS priorities away from patient care, creating a culture where ticking boxes is more important than giving patients the treatment they need. We can’t go on with an NHS that puts targets before patients.

Conservatives understand the pressures the NHS faces. In recognition of its special place in our society, we are committed to protecting health spending in real terms – we will not make the sick pay for Labour’s Debt Crisis. That does not mean however, that the NHS should not change. When you’re more likely to die of cancer in Britain than most other countries in Europe – and when the number of managers in the NHS is rising almost three times as fast as the number of nurses – the question isn’t whether the NHS should change, it’s how the NHS should change.

Health expenditure per person in Scotland has traditionally been higher than it is in the rest of Britain. This is partly because we have some greater health problems and a disproportionate number of areas of deprivation, so the costs could be expected to be greater. This historical anomaly has resulted in a safety margin in the Scottish budget which has allowed for a limited squeeze without too much funding pain. Alas, this luxury may no longer available.

While NHS spending in Scotland is decided by the Scottish government, the money to pay for it comes from the Scottish block grant which comes from Westminster and is calculated using the Barnett formula. This means that if the NHS budget for England and Wales is protected, the same level of protection will be applied to the element of the block grant which covers health expenditure in Scotland. The decision as to how that money is spent however, lies with Alex Salmond's government in Edinburgh. While the Conservatives have made their commitment to protect the funding for the NHS, no such commitment has yet emerged from Scottish National Party.

The NHS in Scotland is something which we should all be proud of. As the pressures of funding begin to bite, things will not be easy for the men and women who provide health care in our hospitals and our communities. A new Conservative government will do every thing in its power to protect the health service, but in Scotland, an equal level of commitment will be required from the Scottish Government. The Conservatives will not turn health care into a political football – we must hear that same commitment from the Government in Edinburgh.

This commitment will also need to extend beyond the allocation of funds. In order to get the best for everyone in these difficult times, some reform of the structures to provide better efficiency, ensuring that much more of the resources reach the front line and much less goes into bureaucracy, will be necessary. David Cameron's reform plan, detailed in his Draft Manifesto, is based on the methods of the post-bureaucratic age – decentralisation, accountability and transparency. These lessons must also be learned in Scotland.