Winter did not go well in accident and emergency units in Scotland.
Statistical comparisons with performances elsewhere are nothing to the point. Too many problems, somehow worse because they are so familiar, have resisted every form of political treatment.
Were things otherwise there would have been no need for an A&E "action plan" from Shona Robison, the Health Secretary. Waiting time targets, the targets that matter, have been missed repeatedly. Some £9 million has had to be found in the Unscheduled Care Fund. Six "essential actions" required of hospitals have been identified. There is nothing, nothing at all, wrong with any of that.
Nevertheless, caveats are required. First, it is worth remembering that ministers were not exactly quick to recognise the existence of problems during the winter. Secondly, while it is wise to act now, as the weather improves and waiting times shorten, no one should pretend that £9m goes far in the NHS in any season. A relatively tiny sum speaks of limited ambitions. With Holyrood acquiring more financial powers, priorities need to be established.
Then there are those half dozen essential actions. The latest plan arrives, in fact, in year three of a £50m Unscheduled Care Action Plan first announced in the spring of 2013. Given the travails of the winter just past, we are entitled to ask what, if anything, was achieved in years one and and two. The evidence is clear: not enough.
Those promised "actions" do not inspire complete confidence, meanwhile. "Empowered hospital management": what does that mean, exactly? "Realignment of hospital capacity and patient flow": that sounds like the institutional common sense this newspaper has been calling for since 2013. "Operational performance management": is that - in plain language - keeping your eye on the ball?
Let us not be too harsh. Better co-operation between departments in the acute system strikes a lay person as something that ought to happen as a matter of course. If it has been neglected, the problem should be remedied. Seven-day services would fall in the same category, even if that has been talked about since 2014, with few concrete results. The ambition to have patients cared for in a home setting is venerable, but if the minister is determined she should be encouraged.
None of this is misguided. Each commitment remains, nevertheless, part of a jigsaw. The history of the NHS says that, unless the picture is recognised and understood, every response to a seasonal crisis will remain piecemeal and provisional. When institutional understanding is lacking, a Gordon Ross, unable to make hospital appointments because of his Parkinson's disease, is denied ambulances and home visits from his specialist. The bureaucratic failure is lamentable, the human results worse.
Our NHS: Time for Action campaign has asserted repeatedly that a wholesale review of capacity in both health and social care must be the foundation for Scotland's health service, above all for the sake of the elderly. Plans must be made, and made now, for an ageing population. The aim, with every statistical means available, must be to keep patients out of hospital, not trap them within a stressed system.
The signs are that Ms Robison and others understand all of this. But the bright summer hopes of still another short-term action plan are a long way short of sufficient.
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