The Covid pandemic revealed the need for closer and more formal links between the UK and Scottish Governments so that we are better prepared to face down emerging health threats, a report by Our Scottish Future says today.
Based on interviews with senior figures in both the London and Edinburgh governments, the paper calls for the close working relations built up between Health Ministers during the pandemic to become a permanent feature as we prepare to combat health threats such as air pollution and bioterrorism.
It also backs more joint working between the Westminster government and the Devolved Administrations to help reduce the huge hospital waiting lists which have been built up during the pandemic, and to support the efficient purchasing of PPE and new life-saving drugs.
The report says the greater cooperation should be led by Number 10 and backs quarterly meetings with the Prime Minister and First Ministers of the UK.
Writing the foreword to the report, Professor David Kerr said that while the delivery of the vaccine showed the country functioning at its best, there was also a “deficit of cooperation and coordination between the UK and Scottish Governments which only risked potential damage to our response to the disease.”
He concludes: “The health professionals and experts we have already spoken to are clear: in the coming years, cooperation will be vital if the NHS is going to continue to meet demand, keep apace with medical advances, and do so efficiently.”
“The NHS is our best loved and most trusted public institution. It is by working together cooperatively across the UK, that we can keep it that way and strive to provide health equity for all our citizens.”
The report says that the pandemic represented the ultimate “stress test” for cooperation the UK and Scottish Governments. It notes that while joint working got off to a good start when the outbreak emerged last February, it collapsed in the summer when, amid a series of political rows, communications appear to have ceased entirely.
The paper says the “jury is out” on reforms to the UK state but welcomes fresh attempts to agree a plan for intergovernmental relations and the publication of new joint UK wide frameworks on public health and health security.
In conclusion, authors Eddie Barnes and Evie Robertson write:
“Ministers and officials from across the UK were faced with an unprecedented emergency in March 2020 and, at their best, they performed heroically in search of common solutions. This was exemplified by the way the various NHS agencies across the UK mobilised at speed to prepare for the first wave, and by the remarkable vaccine effort earlier this year, when genuine collaboration and cooperation supported a national effort to protect thousands of lives. At other moments, however, relatively minor differences in emphasis and presentation between key politicians across the UK led to a breakdown in effective engagement between the centre and the nations of the UK, potentially putting public safety at risk.”
“Given the fact that the decisions taken by the four administrations were notable for their similarity and uniformity, this must be a cause for concern and for reflection by governments across the UK. If we are to learn the lessons of the pandemic, avoid political turf wars, and create a truly cooperative Union, then a more formalised working relationship between the UK Government and the Devolved Administrations should be mapped out with urgency. This will not just support better governance of the next health crisis to hit the UK but will also deliver better government across the United Kingdom in every area of public policy.”
The full report can be found here.
Our Recommendations
1. Creation of Permanent, Formalised and Open Lines of Cooperation between Governments on Shared Health Challenges across the UK. When it comes to future pandemics, the continuing risk of Covid, of from other major health risks such as air pollution, bioterrorism and microbial resistance, we work best when we work together. We welcome the steps already being taken to formalise the ad hoc arrangements for collaboration and cooperation on health security and health emergencies and urge our Governments to work harder so that experts, Ministers and officials from across the UK are in regular and close contact on a standing basis. It should not require a once-in-a-lifetime pandemic for Ministers across the UK to form a working relationship with one another. New forums of cooperation should ensure that Governments from across the UK are able to hold strategic level discussions and develop policy in areas where they and the UK Government have a shared responsibility. This could – and should – extend to having a formalised steering committee, meeting regularly without fail, to develop joined up policy areas, and providing an arena where experts can be invited to collectively share knowledge and recommendations to not just Westminster, but regional governments as well.
2. The new UK Health Security Agency should coordinate closely with the devolved administrations to examine how more joint working can protect the UK from health threats. Public health is devolved and should remain that way, but the experience of Covid shows that close collaboration between UK health agencies and their counterparts across the country is essential in coordinating a quick and effective response. The UK Health Security Agency should look to organisations such as the Centre for Disease Control (CDC) and FEMA – and their interaction – for best practice on joint working and mobilisation to counter threats.
3. A United Response across all Four Nations to Deal with the Aftermath of the Pandemic. We believe that there should be a united response across all four Nations to coordinate the response to dealing with the aftermath of the pandemic in terms of the massive backlog that has built up as resources were diverted, rationally, to deal with the extraordinary challenge of COVID. We saw great examples of cooperation between ambulance services North and South of the border, utilising spare capacity for the benefit of all. The UK became a world leader in managing hospital waiting times and we recommend that clinical networks are established to work in unison to use every scrap of capacity and respective resources we have to deal with our collective backlog. We define a Network as an often geographically disparate group, united by a common aim, one might argue, the underpinning ethos of our truly National Health Service.
4. The Prime Minister should be at the centre of these changes. The draft Intergovernmental review proposes that he chairs one annual meeting with the First Ministers of Scotland and Wales, and even suggests he could passed on to a “nominated deputy”. At a minimum, the Prime Minister should commit to quarterly meetings with the First Ministers.
5. A review of Drug and PPE procurement processes across NHS England, Scotland, Wales and Northern Ireland in light of key learnings from the vaccine procurement plan, to consider where the UK can best leverage its ‘scale and buying power’ to bring efficiencies and value for money for taxpayers, whilst adhering to competition frameworks in place.
