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Patient trust in the NHS is now on the danger list

IN any row about the NHS you can set your Swiss watch by the arrival of one man – Aneurin Bevan.

There is no sitting around for the ghost of the Labour Health Minister and founder of the NHS, no waiting patiently behind Joe Patient or Dr Harassed for a mention.

Particularly if Labour is involved, it is straight to the head of the queue for the JFK of the Valleys. For Labour, there is no better way to show how much the party can be trusted on the NHS than by reminding the public who built it.

At First Minister's Questions yesterday, it almost seemed as if a miracle was about to happen as Johann Lamont, the Scottish Labour leader, neared the end of her questions without a mention of the member for Ebbw Vale. Then the temperature dropped a few degrees, birds fell silent and the great man was among us. "Nye Bevan never put press releases above patients," said Ms Lamont, accusing the Scottish Government of playing politics with people's operations.

Alex Salmond duly hurled the criticism right back. Had you been sitting at home, ill and waiting for an operation, watching this would have been as much use as putting a sticking plaster on a broken leg. In all the heated debates about whose hands the NHS is safest in, the public could be forgiven for thinking most politicians at one time have had their paws in the cookie jar, pulling out tasty statistics to serve their purposes and ignoring those that do not.

It was not supposed to be this way, of course. The SNP had made much capital out of Labour's failure to cut waiting times. New rules, brought in by Nicola Sturgeon, then Health Secretary, were meant to transform the system, making it fairer and more transparent. From 2008, if a patient declined an appointment for "social reasons", for example they could not get time off work or they were on holiday, this period would not be included in their overall waiting time. They stayed on the list and did not lose their guarantee of treatment within a set time.

Then a funny thing happened on the way to meeting waiting list targets. A lot of people began to be marked down as socially unavailable. In its report published this week, Audit Scotland found the use of the socially unavailable code rose from 11% of patients in 2008, to more than 30% by June 2011. Then another funny thing happened. After NHS Lothian was caught using the code to manipulate waiting lists, the overall use in Scotland fell.

In its response, Audit Scotland said the reasons for this rise and fall were unclear, due, in part, to the lack of evidence in patient records. Others will conclude, however, that the numbers show what went on in NHS Lothian was likely not an isolated incident. Either way, the figures could not be relied upon. Patients, once again, were not being given the level of service promised. Trust had again been abused.

Trust, as Mr Bevan knew, was one of the foundation stones of the NHS. Free, safe, reliable health care was to be a right for all, not a privilege for the few. No society, wrote Mr Bevan in In Place of Fear, can legitimately call itself civilised if a sick person is denied medical aid because of lack of means. What would he have to say about them being denied aid because of political expediency or incompetence?

As proceedings at Holyrood yesterday showed, there is nowt like the NHS to raise the blood pressure of politicians. It is the ultimate hot button topic, the area that no party wishing to get into government or stay there can afford to neglect.

When it comes to the NHS, politics does not get more personal. This is a country, remember, that given the chance to throw a spotlight on Britain at the Olympics opening ceremony, wheeled out kiddies in pyjamas and dancing nurses. The NHS is to the UK as nukes are to North Korea.

This is particularly the case in Scotland, where geography and generations of poverty place more demands on the service. Like the rest of the UK, we knew the NHS was broken in parts. Unlike the rest of the UK, we kept faith that the way forward was not to go down the route of allowing market forces freer reign. We may not have had the appalling scandals elsewhere in the UK, but we cannot say either that our health service is delivering as it should.

Now, adding to the pressures, the NHS in Scotland has become part of the independence debate. The way Labour chooses to frame it, the SNP is too concerned about making the case for independence in the future than it is serving patients in the here and now. The SNP, for its part, says the problems are "historical", changes have been made, and it will brook no lectures from a party that failed to cut waiting times when it had the chance.

What both fail to realise is that the public has long thought of the NHS as being above politics, and they wish the political parties would catch up. The public simply wants a system that can be trusted, a system that is monitored closely to ensure reforms are working.

The great waiting list mystery is embarrassing for the SNP, not least because the Minister in charge of health was, as is now, the Minister leading the charge for an independent Scotland. The SNP has built a reputation for being a working, delivering government, serving all the people of Scotland. If it is not seen to be taking charge on day-to-day matters, few will take a punt on it delivering a prosperous independent Scotland. After all, if you allow the odd health body to run rings around you, what chance negotiating a good deal on separation from the UK?

As for Labour, the public's verdict on their running of the NHS was delivered at the ballot box, in both UK and Scottish elections. Nye Bevan, for all the party cites the man when the going gets tough, would have howled in dismay at the money Labour spent on the NHS only to have so many opportunities squandered.

To put it simply to both parties: it is not about Nye; it is not about Nicola; it is about winning and keeping the trust of patients. As of Audit Scotland's report, that trust is now on the danger list.

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