A ROAD-MAP recommending a route away from the impending financial catastrophe that was about to hit the NHS in Scotland was offered to the Government more than a decade ago. It came complete with its own tool-kit. “In planning the future of the NHS in Scotland we need to ensure sustainable and safe local services; redesign where possible to meet local needs and expectations –specialise where required having regard to clinical benefit and to access; view the NHS as a service delivered predominantly in local communities rather than in hospitals.”

These are the words of Professor David Kerr, one of the UK’s leading health experts. They were contained in a report published by the Scottish Executive but never acted upon. The next year the SNP came to power, where they have been ever since. Professor Kerr’s report was never acted upon. As well as providing a snapshot of the landscape of healthcare in Scotland, Professor Kerr also recommended specific actions to make it easier for any government to address the unique health challenges faced by the country.

He recommended “preventative ... care rather than reactive management” and developing “new skills to support local services; generalists as well as specialists; nurses and allied health professionals as well as doctors”. In the foreword to his report the professor anticipated the pattern of pressures on healthcare faced by Scotland. He wrote: “Given the extraordinary health pressures we face from a rapidly ageing population, dwindling birth rate, imposed working time directives from Europe, changes in working patterns, evolving technology and an ever expanding health gap between rich and poor, it should be obvious to all that the status quo definitely cannot be an option.”

The status quo though, is exactly the option chosen by the SNP Government. The review of the NHS by Audit Scotland, published this week, reinforced the accuracy of Professor Kerr’s predictions and spelled out the consequences of the SNP’s failure properly to act upon any of it. Caroline Gardner, Scotland’s Auditor General, said funding to implement the shift in the balance of care from hospitals to the community over the next decade “has not changed course”.

She pointed this out, remember, more than 10 years after Professor Kerr recommended change in this area. Change though, is an alien concept to the small army of super-annuated jobsworths charged with running our hospitals and who are chiefly responsible for bringing about change. None of them will lose their job over this and so will still be endlessly job-hopping around Scotland health boards in what has become known as the great Scottish health pension top-up.

The response of Paul Gray, the head of the NHS in Scotland, was revealing and depressing. Mr Gray wants us to give him four years to fix the NHS. He has been employed in government for 37 years and has been rattling around the NHS for most of the last decade, which means he must have read the prophetic warnings contained in Professor Kerr’s report. When Mr Gray retires, his voluminous pension pot will be intact and free from any penalties for overseeing a department that has been failing during every minute he has spent in the job.

Most people in work these days get around a maximum of four months to make a success of their job; this man wants another four years on top of the several he has already spent in the job. He is the type of civil servant who gets ministers the sack and his boss, Health Secretary Shona Robison, must remove him now if she is not to become another ministerial victim of Scotland’s untouchable and unaccountable civil service.

A few snapshots have been provided recently that offer clues to the chaos that reigns inside a structure that swallows up more than a third of Scotland’s entire budget. Take, for example, the Government’s desire to shift the focus from hospitals to primary and community care.

Unlike areas such as hospital waiting times and access to acute care, no targets have been set to measure successfully how integration is working. Targets in these areas are difficult to measure, according to the civil servants. This is nonsense. Current waiting times for access to mental health care are, for many, almost a year. The Government simply doesn’t want to set targets in this area because it knows they will be added to the list of failures in other areas.

Yet, as every health professional knows, if the service doesn’t have a target then hospital managers and chief executives won’t prioritise it. As for the Government’s much-vaunted and long-awaited masterplan for integration of health and social care itself, are there any targets or measurable outcomes?

The Audit Scotland report warned the NHS in Scotland is facing cuts of £500 million, yet it also revealed some locum consultants are charging NHS Greater Glasgow and Clyde £400,000 a year to cover staff shortages. In other sectors this would be called bribery. Who scrutinises the productivity of hospital consultants in Scotland? In these challenging circumstances who is looking at how much time consultants are spending on non-clinical rather than clinical duties. And why do we still allow NHS-trained and funded doctors to work in private facilities when waiting times are so chronically bad in the NHS that we are having to pay these same consultants again to do locum work? This isn’t healthcare; it’s a grotesque version of Who Wants To Be a Millionaire.

Let’s look at another example: shared services. For the last two years a solution has been sought to consolidate the laundry services in health boards. There’s an unavoidable business case for sharing this service and also a strong productivity case. Yet hospital managers are no nearer an agreement and it looks like the plan is being kicked, ever so gently, into the long grass, a graveyard where most ideas for cost-saving in Scotland’s public sector currently abide. If hospital chief executives are reluctant to change on something as basic as a laundry service then how can they be expect to effect change in the big areas?

It was revealed three months ago three local health boards, Tayside, Fife and Ayrshire and Arran, require special Government help over acute financial problems. Apparently (I kid you not) they are all getting together to “learn from each other”.

During this week’s Prime Minister’s Question Time at Westminster, Theresa May made a commitment to look at parity between the waiting times targets for acute care and mental health. Mrs May is leader of the party the SNP said could not be trusted with the NHS.

The Tories in England might indeed want to dismantle the NHS in the long term as their critics claim. Yet, managing it so incompetently in Scotland that it’s no longer fit for purpose, is just as bad.