The 2021 Scottish Parliament election campaign might not have the usual buzz that we’ve come to expect, but it has not stopped the main political parties from announcing bold policies on health. This article examines some of those policies, taking a closer look at what each of the main parties have proposed, in chronological order. The analysis is by no means exhaustive, but it does pick out some of each party’s key health policies.

It should be stated, from the outset, what the Royal College of Physicians of Edinburgh has proposed in its election manifesto. The College recognises that physicians have been under severe pressure due to increased demand from COVID-19 admissions to hospital, and has called for the creation of an independent working group, which would assess the short, medium and long-term impact of COVID-19 on the medical workforce.

The College has called for a range of other policies too, including an external invited review to learn the lessons from Scotland’s pandemic response; action to support long-COVID patients and on drug-related deaths including decriminalisation and safe consumption facilities; prioritising the restriction of price promotions on food and drink high in fat, salt and sugar; and a review of the minimum unit price (MUP) of alcohol linked to affordability, and uprating it where this will optimise MUP’s benefits.

The Scottish Greens

The Scottish Greens recognise the impact of COVID-19 on health inequalities and on life expectancy. They believe that everyone should have access to healthcare and wellbeing support. The party also recognises the significant backlog on consultations and elective procedures and believes that the health service should be properly funded to address the backlog. The Scottish Greens believe that Scotland must develop robust PPE procurement processes, put in place long-term support for a domestic manufacturing industry, and ensure stockpiles are adequate to meet future demand. On workforce, the party has proposed ensuring that healthcare workers have access to dedicated mental health support and counselling, ensuring access to healthy food and hydration in the workplace; and supporting flexible working for healthcare workers. Regarding air pollution, the Scottish Greens say they will introduce increased monitoring of air pollution that can be communicated as health alerts to people with lung conditions.

On public health, the Scottish Greens want to remove the barriers to participation in sport for everyone. They want the creation of a Minister for Sport; free access to sport and physical activity for children and young people; and to develop a national strategy so that older people can participate in sport. On drug-related deaths, the Scottish Greens back the College’s calls for the introduction of safe consumption facilities and a national heroin assisted treatment programme. They also back a person-centred approach with a focus on drop-in services and crisis centres. Finally, on alcohol, the Scottish Greens want to introduce mandatory unit, calorie and ingredient labelling and prominent health warnings on all alcohol products; make the licensing system more transparent; ban outdoor alcohol advertising and advertising in public spaces; and end alcohol sponsorship of sports events.

The Scottish National Party

The Scottish National Party (SNP) have committed to increasing front line NHS spending by “at least 20%”, in order to help the health service recover from COVID-19. The SNP say that over the next 10 years, they will spend £10 billion to replace and refurbish health facilities. The party has also committed to creating a National Care Service including a 25% increase in social care spending. And as the party announced pre-election, it plans to offer NHS staff a 4% pay increase, however this excludes consultants. In addition, the SNP has accepted calls for a public enquiry into the response of the Scottish Government to COVID-19, and will commission one if elected. Another legacy of the pandemic is long-COVID, and the SNP back the College’s call for support for long-COVID patients. The SNP pledged to give support to GPs to coordinate multidisciplinary care for long-COVID patients. On cancer, the SNP will spend £18 million on a partnership with Macmillan to ensure that everyone in Scotland gets personalised care.

On drug-related deaths, the SNP have committed to a £250m drug deaths fund over the next 5 years. This funding will go towards community based interventions, including primary intervention, and an expansion of residential rehabilitation. The SNP reiterated their support for safe consumption facilities. On alcohol, the SNP want to introduce advertising restrictions in places where children are exposed; and on smoking, the party reiterated its ambition to make Scotland smoke-free by 2034 and committed to publishing a new tobacco strategy. The party also committed to halving childhood obesity by 2030; to make Active Schools programmes free to all by the end of the next parliament (2026); and to bring forward legislation to restrict food and drink high in fat, salt and sugar.

The Scottish Liberal Democrats

The Scottish Liberal Democrats, too, recognise the challenges that COVID-19 has brought to the NHS. They want to see health service recovery, and the backlog of consultations and treatments, prioritised. As part of that, the party wants to increase the number of diagnosis and treatment centres within health boards, and to consult NHS staff on which service innovations, including technology and digital, will be essential to rebuild the health service. And the Scottish Liberal Democrats want to give patients a “clearer picture” of how long they must wait for diagnosis and treatment. The party is calling, too, for a bigger range of specialists, diagnosis and treatment in local communities, and have committed expanding the services available in GP surgeries, as well as increasing the number of GPs.

On mental health, the Scottish Liberal Democrats want to set a target for 15 per cent of new health spending to be directed to mental health; train more mental health specialists for community centres, hospitals, workplaces and schools; and provide more walk-in services at mental health emergency centres. On drug deaths, the Scottish Liberal Democrats back the College’s calls for establishing a nation heroin assisted treatment programme and safe consumption spaces; and decriminalisation of the possession of drugs. On public health, the party wants to reinvigorate the Detect Cancer Early programme; get blood pressure checks in more places; support wellbeing by making it easier for people to use active travel; use the education system to promote healthy lifestyles; and to establish a clinical network to research and support long-COVID programme.

The Scottish Conservatives

The Scottish Conservatives recognise that the legacy of the pandemic will have a lasting impact on mental health and the health service, including long-COVID patients and those who have experienced treatment delays. The party committed to protecting NHS funding by enshrining a ‘double lock’ in legislation, and reiterated their commitment to the values upon which the NHS was founded. In addition, they will back a £600m fund to tackle the backlog in the NHS, above annual increases to the health spending budget. As part of that, the Scottish Conservatives want a clinician-led programme to establish which groups of patients must be seen and treated first, making use of remote consultations and within the framework of a 7 days a week health service. And the party wants to support NHS workers, including physicians, by establishing a new multi-year pay deal; and by investing in wellbeing services including mental health support and rest facilities.

On public health, the Scottish Conservatives want to encourage healthy diet and lifestyle; to make physical activity more accessible; to improve access to community leisure facilities; and to reduce “rates of smoking, drug use and problematic drinking”. Following the College’s policy, the Scottish Conservatives recognise that the use of e-cigarettes and heated tobacco products must be closely monitored. They want to maintain funding for smoking cessation services while recognising the role of inequalities in preventing people from quitting smoking. On drug deaths, the party would ask the Drugs Death Taskforce to publish a comprehensive review into the provision of drug treatment and recovery services before the end of 2021.

Scottish Labour

Scottish Labour has framed its manifesto as a plan for recovery, including health services. The party recognises the challenges the NHS experienced before the pandemic, which it says have been exacerbated. Scottish Labour wants to get treatment to the people who need it most, as quickly as possible, as well as to tackle the sharp rise in mental health cases and the worsening health inequalities gap, that has been accelerated by the pandemic. The party has committed to a “national mission” of increasing life expectancy by 5 years, underpinned by constantly improving Scotland’s health outcomes, as well as a National Care Service. In terms of health service recovery, Scottish Labour will focus on a catch-up initiative across screening programmes to address the backlog in cancer diagnosis and treatment. On workforce, Scottish Labour will increase resources in occupational therapy and offer a specialist health service in Scotland for staff. The party also want to ensure that staff have basic facilities like hot meals and break rooms. To improve retention, Scottish Labour will offer a working time review to all staff considering retirement, offering more flexible working arrangements.

On public health, Scottish Labour want to eliminate health inequalities, saying that they will focus on health improvement measures that remove the barriers of poverty and inequality. The party will encourage active travel and enable healthy lifestyle choices; introduce a Health Harming Products Bill to regulate the marketing, promotion and labelling of food and drink that has little nutritional value but damages health; create a fund to support mesh-injured women; introduce a social responsibility levy on alcohol sales; and ensure better data collection of smoking habits. On drug deaths, Scottish Labour will adopt safe consumption rooms, alongside expanded community resources, and improve access to residential rehabilitation and treatment.