IT IS inevitable that the NHS should become a battleground at each election, since it forms such a significant proportion of Government spending; across the UK, healthcare is the now the single largest area of expenditure, slightly outstripping pensions, while in Scotland, it will soon account for half of all Government spending.

What is depressing, if equally inevitable, is that sensible debate about the NHS’s funding needs, performance and structural reforms is dodged, weaponised or misrepresented by all the parties. This week saw reports of a sharp decline in NHS performance and the highest ever A&E waiting times in England; while here the Auditor General has warned of an £1.8 billion shortfall within five years if there is not substantial reform. Yet, at UK level, debate amounts to little more than a bidding war between the parties.

In Scotland, criticism of the NHS should be confined to its performance under the current Scottish Government. SNP claims that Conservative spending is inadequate are a distraction; Scotland’s NHS budget, and the stewardship of it, is entirely within Holyrood’s control. Similarly, if the Tories did plan to sell the NHS to Donald Trump (as they don’t, despite the opposition parties’ attempt to insinuate as much), it would not affect Scotland; only Holyrood can alter structures north of the border.

For a decade, the SNP Government has conceded the need for reform. But it admits itself that its plans, particularly on integration, have not progressed quickly enough. It is alarming that there has not been any real attempt to tackle recruitment (indeed, the £390 million savings that have been made have often been achieved by short-term and unsustainable delays in taking on staff), nor to reduce the number of regional health boards, each with their own finance directors and attendant bureaucracies. Worse, five of them continue to require external support to meet their finance and performance targets.

While they claim – correctly – that the NHS needs further resources to meet demand, the Scottish Government has little yet to boast of by way of improvement. Unless, as it often seems to suggest, spending 50 per cent of its budget on NHS Scotland is an aspiration, rather than a threat to other services.

In any case, higher spending has not produced notably improved health outcomes; A&E results are better, but still failing to meet the 95 per cent target. Indeed, only two of the eight key targets on time are being met. Flagship projects, such as the Queen Elizabeth in Glasgow and the Royal Hospital for Children and Young People in Edinburgh, have been plagued with problems that demonstrate – at the very least – inadequate supervision by ministers. Despite the enormous sums ploughed into those new facilities, there has been a 63 per cent reduction in the capital budget over the past decade, leading to a maintenance backlog of almost £1 billion.

On top of that, we have the Royal Hospital for Sick Children in Edinburgh mothballed before it even opened, and a child may have died in Glasgow's Queen Elizabeth University Hospital, yet nobody is accountable.

It is clear that the NHS needs further resources, but more spending alone will not yield significant improvement. The UK as a whole spends about the OECD average per capita on health, but the NHS has worse outcomes on many metrics (especially on cancer, heart disease and strokes) than countries, such as Italy and Spain, that spend less.

Reform need not be a move to a US-style system; France operates a public insurance model, Germany a public/private one, Switzerland and the Netherlands entirely private systems, but all provide universal coverage. But the first steps to improvement must be honesty about what is necessary, and accountability for where the system is failing – and that must come from Holyrood.

Storm in a tea cup

If there is one subject more divisive than Brexit, it is whether milk goes in the tea first or second. But adding milk with the bag still in the cup – as the Prime Minister did in an election video – is definitely unBritish. Even if he has a 14-point lead in the polls, this has scuppered his chances, not just of a decent cuppa, but an election win.