19 Jul 2021

Attention immediately after May’s elections was drawn to Conservatives’ victory in the Hartlepool by-election, Sadiq Khan’s retention of the London Mayoralty and Labour bucking the national trend by strengthening its grip on Wales and the North West of England.

But what of Scotland, where – quietly – lots happened but not very much happened at all, and where all of us in the UK should be watching events with an ever-sharper eye? With the election dust now settled, what does Scotland’s election result mean for the future of the UK, and in particular, the health of the Scottish people?

Scotland is a place of paradoxes and contradictions. Take that Scottish Parliamentary election in May. The SNP, in winning 64 of a possible 129 seats, secured support from an astonishingly large proportion of the electorate. Yet many deem the result to have been below par because failing to secure a majority makes the chances of another independence referendum slimmer, at least in the short term. They won, but they didn’t win.

Despite a pandemic response at least as troubling as the rest of the UK’s, Nicola Sturgeon’s popularity amongst the public would make many a world leader blush. She has an effective parliamentary majority thanks to a compliant group of fellow nationalists in the shape of the Scottish Greens. Yet her route to another referendum looks legally and politically perilous. She has lots of authority but very little power.

By virtue of the SNP being in power at all, regardless of the result of the 2014 referendum, the UK’s constitutional future is in considerable doubt. The borders of the UK’s nations feel more pronounced than ever yet polling suggests virtually no movement of public opinion on the question of Scottish independence since the last vote in 2014. It’s settled but not settled.

These paradoxes – surely reinforced and elongated by May’s election result – have an impact on all areas of public policy and the lives of everyone living in Scotland. But they are noisy and time-consuming. They divert the attention of politicians, officials, civic Scotland, ordinary people from other stuff that could – and perhaps should – be occupying more of their attention.

As Scotland emerges from the pandemic it, like every other nation, needs to reconcile its experience over the last eighteen months and somehow emerge stronger and more resilient as a result.

Take Scotland’s health. Not the health of our politics or the health of the Union, but the health of the five million or so people for whom Scotland is home. In an election held in the midst of a health emergency, Scotland’s health issues over and above Covid were rarely mentioned. Yet there’s so much to talk about, so many questions unanswered, so many opportunities missed, so many people losing out.

Scots can expect to die younger than their counterparts in the rest of the UK and, indeed, younger than anywhere else in Western Europe. Scotland’s drug death rate is not only growing exponentially but is three and a half times higher than the rest of the UK’s and far higher than anywhere else in Europe. Only just over half of stroke patients receive an ‘appropriate’ level of care in Scotland’s hospitals. Real-terms health spending per person increased by only 3% during the 2010s decade while in England over the same, it rose by 10%.

Why? What’s behind all this? The causes are likely complex and long-term, with theories ranging from overcrowded housing to the interface between Scottish local authorities and UK Government policy in the 1980s, and the much fabled ‘Glasgow effect’.

Significant power to shift priorities, make different spending decisions and start a conversation about this sits in Scotland precisely to address challenges unique to Scotland. Who is taking decisions and where does accountability lie? How do we find the time and space to talk about this more? How do we overcome another paradox: that we have lots to talk about on health yet can’t or won’t find the time and space to do so. Assuming that resolving Scotland’s constitutional future will provide the answers is both naïve and irresponsible.

As Scotland emerges from the pandemic it, like every other nation, needs to reconcile its experience over the last eighteen months and somehow emerge stronger and more resilient as a result. Opportunities abound for those – regardless of perspective on Scotland’s constitutional future – willing and able to challenge the notion that the independence debate is the only show in town. Because no matter who governs Scotland and no matter its eventual place inside or outside the Union, the health of Scotland’s people needs to be improved now.

May’s election cemented the constitution as a feature of Scotland’s public discourse for at least the next five years. But it doesn’t need to be the feature. How prominent improving Scotland’s health is in that discussion is within the gift of everyone in Scotland to determine. The challenge for us all is to carve out time to get health onto people’s agendas, dismiss the status quo, cut through the paradoxes and to make evidence-based policy the key to Scotland’s improved health.