SCOTLAND has the only government in the world which, while seeking freedom from an unfriendly parent state, is also asking it to send in troops to tackle a domestic crisis.

Yes, soldiers of the British army will be drafted in to drive ambulances in an effort to deal with the present unprecedented pressure on the National Health Service. It’s only September, and a mild September at that, yet in their crammed wards and at their besieged entrances our hospitals are already facing conditions otherwise only familiar from a frozen January.

A union official, Drew Duffy, said: “I can’t see the army being pulled out again until at least spring. You’re looking at a 20-40% increase in calls over winter, due to falls and things like that.”

The use of military personnel would still not solve the novel problem of ambulances queuing on the approach roads, as suddenly soaring totals of Covid patients head for wards where they have to observe social distancing. “We’re assuming the army will triage patients outside of hospitals, so ambulances can get going again. Down south that means putting them in tents – but it’s cold in Scotland.”

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It became suddenly all too obvious how acute the emergency was as huge backlogs led to a patient dying after he had waited 40 hours for paramedics. Last week First Minister Nicola Sturgeon apologised for the “unacceptably long wait” and said she would be seeking “targeted military assistance” to help in coping with pressure points.

Originally, NHS waiting times seemed explicable as side-effects of the fact the population was growing older and treatments were getting more sophisticated. And it was assumed that higher spending in an expanding economy would sooner or later solve the problem.

Somehow, though, the problem has gone unsolved. Waiting times have come to be the most serious obstacle to the continuing popular aspiration for a universal free medical service.

The trouble is that the UK economy is no longer one of the success stories of the western world, and in some years scarcely grows at all. Now, with the Covid pandemic, we have a situation in public health where the bugs will never really go away, but steadily exact their toll winter after winter. We will need to spend more money, of course, yet the mortality will also be more stubborn than in olden times.

Worst of all, this complex of socio-economic problems, boiling over with the medicine we pour in, will become harder to control because harder to predict. In answer to my column on the medical crisis last week, Dr Ron Dickinson of Glasgow wrote in to point out how “since the beginning of the pandemic, Scotland’s total death rate has been 1512 per million population, while England’s has been 2222. Expressed another way, if our death rate had matched England’s, Scotland would have suffered more than 3500 additional deaths.”

The long-term effects may be more comforting. The trouble with coronavirus is that it also has quite contradictory short-term surges.

Dr Dickinson recognised this himself: “For around three weeks now, Scotland’s infection rate has been close to double that of England.”

This has certainly alarmed the Scottish Government and others helping to fight the coronavirus, for the cause of it is not at all obvious: “One possible explanation could be the difference in school holiday return dates. That remains to be seen. However, infection rates for both Scotland and England have been unacceptably high since July, with the Delta (formerly Indian) variant predominant. That is largely due to Boris Johnson closing travel to/from the Indian sub-continent three weeks after he received advice to do so.” But Boris may have changed his mind too often to give us reliable evidence.

When short-term and long-term effects contradict each other, nobody can really say how the total picture will turn out. On the one hand we may just about get through the present crisis (but how about the next one?) On the other hand the NHS may run the risk of being engulfed by Covid, added on to the normal winter flu and delayed treatment for other conditions.

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Whose fault? It is always possible to argue the UK Government has been underfunding the NHS. The health budget has risen by an average of 3.7% a year in real terms since it was introduced in 1948 – faster than the general growth rate in the economy.

At certain points the government has decided to put the whole business on a fresh footing with a sudden jump in expenditure to allow existing claims to be settled and a new start to be made from a higher base. This is just what chancellor Gordon Brown did in his Budget of 2001, in the hope of a permanent solution to the problem of the overloaded NHS. He got nothing of the kind. He did not fully appreciate what a wellspring of grievance, mainly over the pay rates of the staff, the budget had become. He forgot how eagerly the surgeons seek new sources of money for the revolutionary novel treatments they just happen to have waiting to be launched on an NHS that treasures such things. In the first decade of the new millennium, the total spending surged by 6% a year. Amid renewed economic crisis, this could not be sustained beyond 2010, and older disparities re-emerged.

Meanwhile, under devolution, the Scottish Government was not obliged to follow any English example in expenditure and could allocate as it liked what extra money it got. This actually meant that north of the Border the NHS was treated less generously than in England – drugs treatment was not the only thing on which the First Minister “took an eye off the ball”. As a result, Scottish health spending per person, 22% higher than in England in 1999, is just 3% higher today. The Programme for Government presented at Holyrood earlier this month would by 2026 only win back the ground that health spending had lost, nothing more.

Indeed, the Scottish Government has done little to redress the previous policy of underfunding. Since it will not be able to call in the army every time there is a problem, it may in future crises have little choice but to call in the private medical sector.

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A private medical sector already exists in Scotland, somewhat to the disapproval of the Scottish Government. But with long-term growth in our society’s health problems, unmatched by any growth in the public sector, there may be no choice but to make use of what the private sector has to offer.

A day may come when the NHS runs out of the resources the state can supply. In other words, the NHS simply ceases to exist as a universal service, beyond the limits imposed by the lack of resources. It will be privatising itself.