Paramedics and postmodernists

The ambulance crisis is emblematic of Nicola Sturgeon’s approach to government.

Journalism encourages a certain cynicism about the world.

Every politician is a liar, every businessman a crook. The champion athlete is on steroids, the sunny comedian a secret drinker, and the sobbing husband at the press conference always, always the one who did it.

The celebrated US journalist Janet Malcolm once characterised her trade as ‘morally indefensible’ and while I wouldn’t go quite that far, spend long enough hanging around courts, committee rooms or crime scenes and you begin to harden your heart with misanthropic bravado and a cold, black sense of humour. 

It’s not the done thing to admit this but last week, for the first time in a long time, a story got to me. It was the tragic tale of Gerard Brown, the Glasgow man who died after waiting 40 hours for an ambulance to arrive.

Given Mr Brown was 65, had survived cancer, and was afflicted by other health problems, it would have been appalling if he had had to wait 40 minutes for medical assistance. Then I read an interview with his son Dylan, who relayed what the family GP told him: ‘Dylan, I can assure you that if they'd got to him your dad would still be here.’ 

That broke me. When you write about politics day in and day out it is easy to think of it as one big football tournament. Is the yellow team or the blue team at the top of the league this week? Did Labour’s star striker break through the Scottish Government’s defences and will the Lib Dems’ new gaffer switch up their tactics?

The sad, needless way Gerard Brown left this world, and similar stories of vulnerable patients caught up in the ambulance crisis, are a reminder we shouldn’t need that politics — the bits of it that actually matter — is about people and whether or not they are being treated right.

Nicola Sturgeon would no doubt disapprove of the phrase ‘ambulance crisis’, given how she danced around the term at First Minister’s Questions. That is unfortunately a hallmark of her premiership: the naming of a problem is more important than the fixing of it. 

The First Minister is one of those people who puts a great deal of faith in language and perhaps as someone who earns his crust with a pen I shouldn’t object too vigorously. But this mindset, which took grip in the 1990s and reflects fashionable theories inculcated at universities in the two or three decades beforehand, has been ruinous to the notion that you go into politics to do things rather than talk about them. 

Postmodern politics, a tradition to which Sturgeon very much belongs, prizes rhetoric above everything, even reality. This is what lies behind her approach to government, with its relentless emphasis on acknowledging issues, defining challenges, expressing sympathies — but never getting round to attacking the underlying causes.

If there is a hashtag to be tweeted or a lapel pin to be worn, Sturgeon is second to none in capturing the mood and striking an appropriate tone. If it is the material conditions of the matter that you want changed, she is not your woman. 

The ambulance crisis — and it is a crisis — is an object lesson in the limits of the Sturgeon school of politics. For her five years as health secretary and seven as First Minister have been a tornado of words about the NHS — and a limp wind when it comes to actions.

This present crisis, for example, can’t be the fault of single-crewing of ambulances. That practice has been eliminated. We know this because Nicola Sturgeon told us so. 

In June 2008, she instructed the Scottish Ambulance Service ‘to achieve the elimination of single manning’. By January 2012, she was telling the Scottish Parliament that ‘single crewing… has been substantially eliminated’, ‘single crewing has, as of late 2010, effectively been eliminated’ and that, ‘[t]hankfully, single crewing is no longer routine in the Ambulance Service’.

Between 2013/14 and 2019/20, there were 18,999 shifts with only one crew member in an ambulance.

Nor can the problem lie with excessive waiting times for hospital treatment. Those, too, have been abolished and we can say that with confidence because, once again, Nicola Sturgeon told us so. 

The 2007 manifesto that brought the SNP to power promised voters ‘you will have your own personal and legally guaranteed waiting time’. Following her party’s victory, the new health secretary told Holyrood: ‘[T]he point of legally binding guarantees is to ensure that patients’ rights are meaningful, that guarantees are not breached, and that patients get the treatment they deserve’.

Sturgeon enshrined her Treatment Time Guarantee in the Patient Rights (Scotland) Act 2011, which, per her government’s statutory guidance, meant health boards would now ‘be required in law to ensure that patients start their treatment within 12 weeks’. 

Since it came into force, the legally binding waiting time has been breached more than 300,000 times. 

Ministers routinely invoke the pandemic to explain away their failings and because most people have lives and jobs and no particular affinity for the NHS statistical archives, they shrug and figure that this sounds plausible enough. Not only is it not plausible, one perverse facet of Covid-19 is that it has actually helped ministers meet some targets.

Take the A&E waiting time standard, which says that 95 per cent of patients should receive emergency care within four hours of arriving at hospital. That target was missed every single month from September 2017 to April 2020, then, suddenly, it was met in May, June and July of that year.

What changed? Did the Scottish Government draft in more doctors and nurses or invest in additional capacity in emergency wards? No, the words ‘coronavirus’ and ‘lockdown’ came into our daily vocabulary and the number of patients presenting at A&E dropped off a cliff. Where 151,000 had sought emergency treatment in May 2019, only 87,000 did so in May 2020.

With the health service undergoing what ministers call ‘recovery’, the four-hour target is once again being consistently missed. July saw just 81.5 per cent of A&E patients treated on time, the worst performance in any month since the SNP came to power 14 years ago.

There are many more examples from health and from across the ministerial portfolios. The SNP’s rule is government by pronouncement and if it seems as though pronouncements are rarely followed by measurable outcomes, that is because the pronouncements themselves are the business of government. Nicola Sturgeon’s governing philosophy is: I press release, therefore I am. 

Whenever the First Minister is challenged on outcomes, she invariably pivots to intentions, and suggests her critics are impugning those. I don’t doubt the First Minister’s intentions. I say intentions are not enough.  

I was sorry to see Annie Wells resign from the Scottish Tory front bench last week for health reasons.

The 49-year-old was part of the 2016 intake and brought a much-needed gust of fresh, plainspoken air to Holyrood. A former shop worker, Wells is as gallus and as Glasgow as they come, remaining close to her roots and loyal to the people she knows best: the city’s poor and put-upon. 

Though many of them would never dream of voting Tory, they are the very spirit of Wells’ worldview. That spirit is hard-working, good-humoured, proud and determined that, however scarred communities are by social ills, they will still be safe, decent places to live, raise a family and grow old.

Some Tories call themselves blue-collar conservatives but Wells doesn’t much care about the colour of someone’s collar — she’s too busy rolling her sleeves up. 

We need more like her in politics. I send her my prayers and best wishes for a speedy recovery.

Speech of the Week: Labour’s Michael Marra for reminding Holyrood of the worth of work during the fossil fuel transition debate.

‘Industry — which puts wages in pockets, food on tables and taxes into our public services — must grow rather than recede.’ Take note, Green poseurs and posturers: this is how a real socialist talks.

Originally published in the Scottish Daily Mail on September 20, 2021.

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