
“We will cut our waiting lists.” With this declaration, John Swinney tied his future to delivering something that has so far proved well beyond the SNP.
Launching his plan to reform the NHS, the First Minister this week promised “tangible improvements that we can and will deliver.” It was hard not to be impressed by his certainty. It was equally hard not to be sceptical about the prospects of delivery.
This isn’t based on doubts around Swinney’s personal commitment to change. I’m told that he has taken control of health reform, aware that it’s the voters’ top priority and therefore the best route for the SNP to win the 2026 election.
But public sector reform and the Nats have always made for uncomfortable bedfellows. Speaking in Glasgow this week, Michael Gove talked about taking on the vested interests in the trade unions and the education establishment when attempting to reform England’s schools. Gove faced them down and as a result England now has an education system that competes with the world’s best. Gove used the word “courage”. In Scotland, no similar reforms have been attempted – no one has wanted to challenge the civic forces of conservatism that stifle improvement. There has been no courage.
So when it comes to fixing the NHS, it’s inevitable that observers will believe it when they see it.
After all, as Gove and the Blairites know, reform comes at a cost – both political and financial. Swinney wants to make operating theatres more productive, and shift the burden towards treatment centres. He wants GPs to step up and reduce the pressure on hospitals and A&E departments. More people will be treated in the community and at home, he said.
This all sounds reasonable and indeed desirable, but it will need to be paid for. AI will have a significant role to play in speeding up diagnosis and treatment, but it won’t come cheap. The care system is a mess – the SNP has just scrapped its plan for a National Care Service – leading to bed blocking and delayed discharge. Sorting that will be excruciatingly expensive. And there is no money without economic growth, tax rises, or cuts to other services. Each of these options is politically tortuous.
On top of this, the NHS is a monster that gobbles up new money and rarely responds to incentives and central direction in the way ministers – of any persuasion – would like.
But the First Minister has said he will “cut our waiting lists”, so there it is. The only option is to wish him well, and to be ready to hold him to account if he fails.
If the jury remains out on the likelihood of delivery, this new version of the Nats certainly gets pass marks for political acuity. Swinney has now jettisoned all of the latter-day Sturgeon policy errors, from gender reform to coastal fishing bans to that National Care Service. He’s gone relatively quiet on independence (for now). All this has freed him up to talk about the public services and the economy, and he is being listened to. There is a sense of rejuvenation in the performance of the government, which is no small feat after 18 years in office.
His task has of course been made easier by the baffling, repeated missteps of Labour at Westminster. Disillusioned Scottish voters, who sent Labour MPs north in such high numbers (37), are left wondering what the point was. Anas Sarwar, who did so much to aid Keir Starmer, finds his own and his party’s poll ratings stymied by the UK government’s unpopularity. He has been forced to distance himself publicly from Starmer on issues such as the two-child payment and the winter fuel allowance, but this has at times seemed opportunistic.
Scottish Labour are rattled, and the longer the SNP stays ahead in the polls, the more rattled they will become. They retain confidence that when voters finally start to concentrate on the 2026 election, the “time for a change” argument will win out. Well, it might – but that was the clincher for Labour at Westminster, and if Starmer doesn’t raise his game then the Scottish electorate might not be quite so persuadable when it comes to Holyrood. There has to be more to Sarwar’s strategy than that.
Behind the scenes, Swinney has been reconstructing the party and government machines. Smart, experienced, politically astute spads from the glory days have returned. The administration is concentrating on the issues that matter most to voters. Ministerial sources say the cabinet, even though it still contains many committed Sturgeonites, is fully signed up to the new direction. They feel supported by Swinney’s focused but inclusive style of leadership – “it’s a benign dictatorship that everyone’s enjoying,” says a source.
It seems to be working at present, to whatever degree – and the First Minister is visibly growing in confidence with every speech he gives. He even had the cheek last week to steal Sarwar’s plan on immigration, which would allow foreign students who graduate from Scottish universities to stay in the country. Government spending is being approached with greater responsibility than it has been since the Salmond era, including through the formation of a powerful new ministerial sub-committee to scrutinise decisions and the development of a strategy for public sector efficiency. Alba is a reduced force following the passing of Alex Salmond. Reform UK is eating into Labour and Tory support. Even internally, the SNP group at Westminster, which was sometimes seen as an alternative power base, was heavily reduced at the general election, and the more rebellious MPs have largely left politics.
It all points to an unexpected opportunity for the Nats to renew themselves in office. Only a few short months ago they seemed finished, but then these are unusually volatile times. Swinney is enjoying his share of luck, but he is also steering events. Now he just has to cut waiting lists.