Reform’s plan for health, care and welfare

UNDER REFORM UK, the NHS in Scotland will remain free at the point of need and will be fully funded by general taxation.

However, it does need reform; a recent poll has revealed that 93 per cent of Scots think that NHS Scotland needs significant change and reform.

Health outcomes in Scotland are deteriorating relative to other countries with similar healthcare budgets, but this is not because of a shortage of money. We spend £20bn annually on health in Scotland, a figure that has increased by six per cent per annum over the last twenty-five years. Yet the Auditor General for Scotland warns that despite more funding and more staff, the NHS in Scotland has become “financially unsustainable.”

The sad reality is that Scotland’s health service is not working under the SNP. Patients struggle to see their GP, hospitals are full, and delayed discharges have not been tackled, which means patients are stuck on wards even when they are well enough to go home. The knock-on effect is that ambulances can’t drop off patients, which means dangerously long waits for ambulances. The whole system is a needless mess.

We can sort this by allowing our brilliant medics and nurses to be more productive by fixing delayed discharges, by removing inept and bureaucratic management, by improving staff retention and morale, and by creating new pathways of care. Health systems around the world are adapting to elderly populations and a new suite of health conditions. With a stable population and world-class medics, Scotland is in a unique position to lead the world again in modern healthcare.

We are paying NHS staff more, only to end up taxing it back again

Our economic plan, even before any further specific reforms, will do much to improve the health service. Scotland already has the most generous pay deal in the UK for most medical professionals, with a new pay deal also required for GPs. We are paying NHS staff more, only to end up taxing it back again, with high marginal tax rates and cliff edges resulting in many of our most experienced nurses, midwives, and doctors being incentivised to cut back their hours. This leaves wards perennially understaffed and GP surgeries perpetually underserved, worsening morale for those at work.

This will end once they no longer face marginal rates of over fifty per cent. The income tax cuts planned for our first budget mean that a resident doctor with five years of experience will immediately take home an additional £2,200 a year by paying less in income tax, while a consultant with one year’s experience will take home an additional £5,200 a year – with still further effective take-home pay-rises in the years to come, all without the need for any further renegotiation of pay deals to raise their gross salaries.

We will immediately establish an independent, expert Scottish Healthcare Reform Commission to undertake an ambitious review of healthcare delivery with action plans on:

A workforce plan to train more doctors and nurses in Scotland
Creative solutions to delayed discharges to increase hospital efficiency
Long-term funding and optimisation of adult social care integration
A shift towards prevention in tackling persistent health inequalities
Expansion of frontline services in the community and GP surgeries
Greater use of technology, including AI and tools such as the NHS England App.

SOCIAL CARE

Our economic plan will immediately improve conditions for carers who support their loved ones. By removing the stark cliff edge they face in the withdrawal of the Carer Support Payment, and instead tapering its removal, they will always have the option of increasing their earnings to support their household.

Our new deal for local government will also give councils greater flexibility and control over their social care services, while simultaneously providing a secure basis for long-term funding.

WELFARE

Reform will overhaul the SNP’s new social security system to ensure that work always pays more than welfare, and to ensure rigorous face-to-face assessment of claimants to prevent overpayment and false applications. This new bureaucracy is costing £0.5bn to administer £6bn of benefits, projected to increase to £10bn. This is unsustainable and distorting the balance of incentive between welfare and work.

The population of Scotland stands at 5.5 million, of whom 3.6 million are of working age. Of that cohort, 2.6 million are active in work and one million are economically inactive. Exempting students, adult carers, early retirees and the long-term disabled leaves around half a million Scots of working age locked out of opportunity and prosperity. This is an incredible waste of talent and a national shame that we must rectify as a matter of urgency.

Our economic plan, particularly the cap on marginal tax rates of over 50%, will go a long way to make sure that work always pays, as will the new job opportunities created by a growing economy. Savings made in welfare will be applied in the first instance to adult-back-to-work and apprenticeship programmes in our 10 leading business sectors.

Work is a key component of the Scottish DNA. And the most effective form of welfare will always be a good job.