The 'desperate plea' made by the entire Accident and Emergency team at the Queen Elizabeth University Hospital (QEUH) in Glasgow does seem extraordinary. The working conditions they describe and the risk to human life they argue is resulting paints a picture that should be of great concern.
The response being made by the Scottish Government and how that relates to its current policy agenda raise equally concerning issues. The Scottish Government has said that this is an 'operational matter' so not their responsibility, only that of the Greater Glasgow and Clyde Health Board.
But the Health Board is an entirely unelected quango answerable only to the Minister for Health. It was established in 1974 and gained its current name and legislative remit in 2006. It has been in charge of health in Glasgow for 50 years and has had its precise current form for two decades.
Under usual circumstances that means that the Health Board would be considered responsible for the fact this problem has emerged and has not been addressed. In other words, if you are in total control for 50 years and things go badly, you are the problem, not the solution.
This demonstrates a major problem in Scotland and raises a pressing question. The problem is that the entire structure of the quango state clearly acts to take decisions out of democratic accountability while handing the responsible politicians a weak kind of 'plausible deniability'.
If the Health Board is failing (and the evidence for the failure of health boards across Scotland is substantial), how can politicians refuse to accept responsibility by hiding behind the failing body and deferring to it?
Just as a reminder, Glasgow and Clyde Health Board is currently subject to a full public inquiry over deaths related to the QEUH, is being investigated by the prosecution service over seven deaths, is bad enough to warrant the last health secretary creating a specialist oversight body for the Health Board and was subject to a damning report from Healthcare Improvement Scotland (HIS).
This last on in particular emphasises the point. The Health Improvement Scotland report specifically blamed the leadership of the Health Board as a key part of the problem and put in place a follow-up review because it was so concerned that relationships between medics and governors had broken down.
In other words, HIS appears in large part to identify the Health Board as the problem. The Scottish Government appears to agree – it doesn't set up 'independent oversight groups' to deal with problematic quangos on anything like a regular basis.
So why is the Scottish Government now saying 'this body we don't appear to have confidence in and have good reason not to have confidence in is in charge and we are not going to intervene with that but rather hide behind it'? It looks disconnected to everything that has previously happened.
And this raises another rather fundamental question – how on earth does merging health boards into two national boards help this problem in any way at all? In fact how does it not make the problem much worse? Glasgow Health Board has five accident and emergency services and appears to be failing to manage them effectively.
The new merged health boards will have 15 each (if divided equally). The West health board will presumably cover accident and emergency departments from Inverness’s Raigmore Hospital to the Dumfries and Galloway Royal Infirmary. The East board will have the Gilbert Bain Hospital Lerwick, Caithness General Hospital in Wick – and the Scottish Borders General.
If the problem in Glasgow is as severe as its entire accident and emergency services say it is and the responsibility is wholly and completely with the Health Board as the Scottish Government claims, and if that Health Board appears to be the problem according to the Scottish Government's own inspection and improvement agency and is being investigated by the police, what kind of system is this?
And how does further centralisation and greater control by the same failing quangos solve the problem? In fact, is health board merger an attempt to solve the problem at all or something the Scottish Government is doing to rearrange the bureaucracies to avoid responsibility?
If there is coherence between 'the problem' and the current proposed solution, Common Weal cannot see what it is.