STEPHEN DAISLEY: Sadly for patients, the NHS has gone down with the sickness of secrecy... a malady that starts at the very top

By STEPHEN DAISLEY, SCOTTISH DAILY MAIL SKETCH WRITER Published: 20:49, 23 August 2026 | Updated: 20:49, 23 August 2026 Picture it: you’re sitting bored in your hospital bed when your eye wanders from the lightly-nibbled poke of grapes on the side table to a headline in a nearby newspaper. Health experts say the NHS is putting its reputation ahead of patient wellbeing. All of a sudden, you’re not so sure you want to go through with this surgery. You’re in for your hip, not to become a plot line on Casualty. The NHS might well want to protect its reputation but you want to be the right side of the sod this time next week. It’s enough to make you don your slippers, clasp your ill-fitting gown closed at the back, and make a run for it before the nurse’s next rounds. In all seriousness, it would be the natural response. Who wants to entrust their life to an outfit that cares more about optics than operations? That, however, is where things appear to stand. Dr Iain Kennedy, head of the BMA in Scotland, warn that a ‘culture of cover-up’ had taken hold within Scotland’s NHS, one in which doctors and others who spoke up about safety or capacity found themselves scrutinised rather than their concerns. Patient safety commissioner Karen Titchener reckons there is a ‘nothing-to-see-here culture’ at work.  NHS users who complain about their treatment are dismissed, she said, ‘as a pest’ or ‘an aggressive patient’. It appeared that, in some cases at least, reputation was being prioritised over the best interests of the patient. There is no dismissing this pair. These are serious people with many years of experience. Dr Kennedy in particular has done yeoman’s work over the years trying to shake ministers out of their complacency about the future of the NHS. At some point, you have to stop spinning and pay heed to the experts. Patients have no union. No one is fighting their corner. They depend on political leaders to be open and responsive enough to recognise problems and work to put them right. Leaders with their heads permanently in the sand are no use to anyone. Dr Iain Kennedy, head of the BMA in Scotland The culture of secrecy is not limited to the NHS. In fact, it can be traced to a devolved government in Edinburgh which scorns transparency and regards accountability as an imposition, if not an impertinence.  There is no need for accountability when the country is being run by clever people with good intentions. They have lanyards, you know. As Dr Kennedy says: ‘The culture is set at the top, at the very top, so it's really important that whoever is first minister in Scotland and the cabinet secretary for health, they set the culture, as do the MSPs in Holyrood.’ That means promoting openness and accountability; encouraging staff to come forward with their concerns rather than fostering a work environment where they fear candour will be regarded as trouble-making or disloyalty. Not just in the NHS but across public services and government. Alas, a government cannot create a culture it doesn’t believe in and this government simply does not believe in honesty or answerability. Ministers will pay lip service to these notions where necessary but judge them instead by the situation they preside over. Secrecy is their preferred mode because they disdain limits on their power and oversight on how they exercise it. Time and again, reasonable requests for information on public interest matters have been met with spin and stonewalling. Is your MSP bothering to turn up to Holyrood? That’s none of your business. You think you have a right to see the WhatsApp threads where life-and-death decisions were taken during the pandemic? Good luck. Those are long gone. Why didn’t the Scottish Government tell the public about a Covid-19 outbreak in central Edinburgh? Because they didn’t, that’s why. You want to see documents about an unlawful government investigation of a former first minister? You can whistle for them. Who do you think you are? When the Scottish Government treats the public’s right to know with such monumental contempt, it is only natural that its subordinate bodies model their conduct likewise.  When that happens in the NHS, patients, professionalism, and outcomes suffer. Public trust crumbles, conscientious employees lower their standards, and the institution fades to a shadow of its former self. The NHS is facing a battle over accountability, with patients often in the firing line What is thoroughly disheartening is that none of this needs to happen. A health service proud of how it cares for its patients does not cloak itself in secrecy. It doesn’t downplay concerns or ostracise those who raise them. It doesn’t monitor patients and their families on social media. Scotland has moved into a post-accountability age, an era in which the powerful look out for their own and the rest of us are left to get on with it. It’s no wonder that accountability is given short shrift in some NHS boards when the system is headed up by health secretary Angela Constance, who refused to resign after breaching the ministerial code and misrepresenting the child protection expert Professor Alexis Jay.  NHS executives aren’t going to put themselves on the line for corporate errors when the health secretary refuses to hold her hands up for personal wrongdoing. Rooting out the ‘It wisnae me’ mentality will take some time given how engrained it has become in the NHS, but restoring accountability to one part of the public sector will always be of limited value, unless it is accompanied by a transparency drive inside St Andrew’s House.  The instinct to conceal must give way to an affinity to truth and integrity; the endemic fear of accountability to a professional milieu in which doing the right thing is not merely tolerated but actively encouraged. The interests and outcomes of taxpayers will have to take precedence over the corporate face-saving of recent years. Within the NHS especially, patients will have to come first. Constance is not the person to lead such an effort, though the SNP benches are hardly brimming with alternative talent.  A generation of Nationalist politicians came up at a time when openness was a source of frustration and resentment. Few of them have a sincere fidelity to process or the capacity for self-criticism that are vital to overhauling public services. They would also have to admit the government’s fault in allowing the cultures we see today fester for so long. The real reputational risk to the NHS is the growing suspicion that this is a service which first and foremost serves itself. That leaves patients feeling unsafe and undervalued and health boards struggling to maintain the trust they rely on to function well. The public’s attachment to the NHS remains strong but it is not unbreakable, and the more that patients see health boards insulate themselves from scrutiny and consequences, the less willing they will be to put their lives and those of their loved ones in the hands of a cynical, closed-ranks bureaucracy. Someone needs to throw back the curtains and let the sunshine of accountability shine on Scotland’s public institutions. No political leader seems up to that task, and so we will continue to tread in the gloom of secrecy.