Judging by Nicola Sturgeon’s reaction, Douglas Ross’s observation that she had become “detached from working class communities” clearly stung.

Undaunted, up she popped in the Financial Times to prove his point, hoping Covid would be sufficiently “in the rear view mirror” to enable her to press forward with “concrete decisions” on another independence referendum. In a remarkable display of hubris, she vouchsafed that demographics are on her side. Pesky oldies, who believe in the UK, are dying off. And youngsters’ intentions can, apparently, be taken for granted. So she’s happy playing a waiting game.

What sort of person looks at Scottish mortality rates and sees political advantage? Shouldn’t Scotland’s First Minister be worrying about our mortality rates, the highest in the UK and Western Europe? And the growing gap in healthy life expectancy between most and least deprived communities in Scotland? Glasgow’s tale of two cities, where a Bridgeton-born man can expect to live 14 years less than one born in Jordanhill? Or bringing down Europe’s highest rate of drug-related deaths?

Cocking a snook at Mr Ross is one thing. Cocking a tin ear at the lived experiences of your fellow countryfolk is quite another. Waiting may be a political game to Ms Sturgeon but for normal folk, waiting is what you do when needing help from brilliant, overworked and heroic staff in the NHS.

The four out of ten immediately life-threatened patients the Scottish Ambulance Service worries won’t get an ambulance within the 8-minute target time. The queues in A&E patiently putting up with the second worst waiting time performance since records began.

The dashed hopes of cancer patients who thought when the SNP passed a law guaranteeing treatment within 12 weeks – the Patients Rights (Scotland) Act 2011 – they actually meant it. Instead a promise broken over 300,000 times since. And not just cancer patients let down. 100,000 Scots with treatment agreed and who still wait for it – nearly a quarter of them for over a year. Some guarantee. About as reliable as Del Boy’s.

And the same story throughout the patient journey. Those waiting for diagnostic tests nearly 30% higher than pre-pandemic levels. Around 400,000 waiting for outpatient appointments – nearly half of them for more than 12 weeks. Miles off the SNP Government’s target.

These are not signs of a crisis that by spring will be in the rear view mirror. They are evidence of systemic failure – a long time in the making, which will take as long in the sorting.

And before agitated from Ochil presses send on another letter to the Editor, note last week’s Reform Scotland blog from Professor Paul Gray. Gray was NHS Scotland’s chief executive for six years until 2019. He wrote: “The current health and care system in Scotland is overwhelmed”, adding: “the current design and resourcing cannot meet the current and emerging challenges and nor are they designed to do so. The current system was going to be overwhelmed regardless of Covid. The virus has simply brought the date of that event forward”.

HeraldScotland: Former NHS Scotland chief executive Paul Gray

If primary care becomes overwhelmed then in time the whole system will become overwhelmed. As Gray explains: “…a dysfunctional primary care system leads to more pressure on hospitals, which in turn means that people with treatable but less urgent conditions are left untreated until their condition becomes acute and unmanageable. Or, if they are frail, they move instead into the social care system, either requiring care at home or in a care setting, and they do so more quickly than they would otherwise have done if they had had access to functioning primary care”. Scotland’s hard-pressed GPs will recognise the picture he paints.

Professor Gray is clear something more fundamental than a glance in the rear view mirror is needed. In his view – based on what works internationally – truly integrated local solutions are required.

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Can anyone be confident, after 14 years, a centralising SNP Government has either the inclination or ability to get a grip of the NHS’s problems? A government, which our highest court – with Scotland’s most senior judge presiding – last week concluded had deliberately legislated beyond its powers. A new excuse justifying a second independence refrendum manufactured. Job done. So much easier to plead impotence than rectify incompetence.

The NHS is consistently Scots’ top priority. If Ms Sturgeon was in touch, it would be hers too. But for the SNP Government it never has been.

Over the last decade health spending per head in England has increased by 10%. The UK Treasury has provided funding for Scotland to match those increases. The SNP has chosen not to – per capita spending rose by just 3%, gradually eroding Scotland’s historic health spending advantage. A significantly higher proportion of total identifiable expenditure is now spent on health in England than Scotland, even allowing for social care differences.

HeraldScotland: Nurses at work

The SNP attempted – with some success – to weaponise the NHS during the 2014 referendum, raising the spectre of creeping privatisation and the end of a service free at the point of use. “In five years England will not have an NHS as you understand it, and if we vote ‘No’ in ten years neither will we” – words from a Yes campaign-promoted video, which went viral. It reveals much about the SNP leadership’s character that their first instinct to revive a failing campaign was resorting to unfounded scare stories to frighten the most vulnerable.

The ‘Vow’ is remembered now as a promise of more powers. For those of us involved in its production, as important was providing this cast-iron NHS guarantee: “And because of the Barnett allocation of resources, and the powers of the Scottish Parliament to raise revenue, we can state categorically that the final say on how much is spent on the NHS will be a matter for the Scottish Parliament”.

The Vow’s promises have aged rather better than the SNP’s threats. How ironic that today the biggest threat to NHS Scotland is five more years of SNP mismanagement.

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