It is not true that one in three Scots have paid for private healthcare

One in three Scots are seeking private healthcare – and 100 per cent of Scots are ginger. That would appear to be the implications of the incorrect interpretation of the survey data methodology used by the British Medical Association to warn that there is crisis in the NHS.

Common Weal is the first to warn that there are serious problems in Scotland's NHS and that urgent action is needed both on demand (our public health agenda) and supply (the organisation and funding of the NHS). But catastrophising – exaggerating problems and making them sound more daunting than they are – absolutely does not help.

The story reported in the Herald is part-headlined 'a third of Scots go private'. In fact this is based on the question 'did you go private and has anyone else in your house and anyone else at all you know gone private?'. The actual number responded is 17 per cent. That is far too high, but it is not one in three.

To get to the one in three number you need to add in the 'or anyone you know'. This, of course, is not a legitimate statistic. To return to our clearly illogical conclusion about redheads, if you ask 'are you ginger or is anyone you know ginger' and add those together, in Scotland you would get 100 per cent. That simply does not mean everyone in Scotland is ginger.

This is important. In social change theory there is a lot of debate about whether understating a problem or overstating it has a more positive effect on achieving a solution to that outcome. This is a particularly live debate in climate science, where most scientists have defaulted to being particularly moderate about the scale of the problems.

But as almost all climate scientists understated their fears over a couple of decades, others asked whether this was part of the problem, that the real urgency of the implications of their scientific assessments was not getting through.

The evidence on this is not straightforward, but as you will intuitively realise, there is a point where making a problem sound too minor will result in inaction and there is a point where making a problem sound so massive and intractable there is nothing you can do about it will also lead to inaction, so in between there appears to be some kind of sweet spot.

In reality there isn't; it greatly depends on social and political conditions and rather than a sweet spot there is a outer range where messaging doesn't work. The rest is judgement, awareness and reevaluation.

The risk comes when messaging drifts beyond that which is likely to induce the action you are seeking and instead induces a different action you want to avoid. This was the factor that, early during the pandemic, mean low-key messaging about stocking up on essentials led not to moderate stocking up of essentials but instead to panic buying that wiped out shop inventories.

In reality the picture is more nuanced than this. For example about the same majority of people are satisfied with NHS care as are unsatisfied with the NHS service. What this appears to tell us is that the process of getting healthcare is causing widespread unhappiness but most people who actually get healthcare have a positive experience of it (59 per cent and 51 per cent respectively).

Common Weal very much supports the BMA's emphasis on the need for urgent, real action in the NHS. Actually, in our own health reform plan we have set out how we think the BMA itself should be reformed as it is an organisation with its own problems.

We are less convinced that making it sound like paying for private healthcare is an 'everyday thing' that 'everyone is doing' is helpful when it is only true of one in six people and where we have no data on what they are paying for (did any of these respondents report paying for extra medicines off-prescription as private healthcare?).

Our NHS is not dying but is at risk of a cycle of terminal decline if action isn't taken on two fronts. Unless we challenge the Ultra Processed Food industry and the social media and corporate culture generally which is creating high levels of anxiety and stress, our health service will always be running up a down escalator.

And so long as we favour the production of management statistics and the maintenance of a costly and ideological internal market in the NHS, we will continue to divert resources away from healthcare and into the administration of health services and the many corporate clients involved in that.

There is one more important point that it is essential we keep in our minds. All of the above trend data and particularly the data on rapidly deteriorating trust in NHS services is tracked back to 2019. It is regularly stated that it was the arrival of the pandemic that was the trigger for all of this. It is almost always forgotten that the period from 2019 until now saw the largest transfer of wealth from the many to the super-rich ever observed in real time in human history. Inequality erodes everything.