On his visit to Scotland this week, his first as prime minister, Rishi Sunak reportedly held “robust” talks with Nicola Sturgeon on independence, as well as discussing the NHS crisis and Holyrood’s controversial new gender law.

Sunak is less toxic to Scottish voters than Boris Johnson but still the Tories face annihilation north of the border, according to a poll in December, which found that even the Scottish Conservative leader, Douglas Ross, would lose his seat in the next general election.

And yet Ross repeatedly lands blows on Sturgeon, particularly over her handling of Scotland’s health care shambles, recently claiming that Scottish medics were working in a “third-world environment”.

The Scottish Tories’ health spokesman, Sandesh Gulhane, who is also a GP, has been even more effective in exposing the failings in the Nationalist government’s management of the NHS.

Calling for the removal of Scotland’s hapless Health Secretary, Humza Yousaf, he said the SNP and Greens spent more time debating independence than the health emergency during a session on Tuesday.

Sturgeon had held a televised press conference on Monday, in echoes of her Covid appearances, ostensibly to address a health service collapse that has seen record A&E waiting times and hospitals dangerously close to capacity levels.

In a sign that health care is at rock bottom, a Ukrainian refugee, based in Glasgow, opted to return to war-torn Kyiv for medical treatment rather than take her chances with Scotland’s delays, it was revealed at First Minister’s Questions on Wednesday.

Sturgeon blames factors beyond her control, such as Brexit, a surge in winter infections and bed blocking, for the crisis.

She has also taken to blaming patients for “unnecessary attendances” at emergency departments, and, by implication, doctors for admitting or referring them.

Such “patient-blaming language” suggested a misunderstanding of the issues, said the deputy chairwoman of the British Medical Association in Scotland, Lailah Peel, and Dr Gulhane agreed, tweeting, “I don’t know a single clinician that would admit someone unnecessarily”.

Sturgeon usually attributes any embarrassing blights on her government to Westminster but health is devolved and, besides, the NHS in Scotland receives more UK funding per head of population than England. 

Under more than 15 years of SNP rule, including Sturgeon’s five-year tenure as Health Secretary, Scotland could have forged its own health solutions, but there have been no serious attempts to reform the NHS or tackle Scotland’s underlying health problems.

Warnings about staff shortages, from the likes of Colin Poolman, director of the Royal College of Nursing in Scotland, have been ignored and possible new ways of working dismissed.

Instead, the SNP has been preoccupied with constitutional upheaval, even though a majority of Scots voted against independence in the 2014 referendum, and the Nationalists have never been able to convince voters otherwise.

Sturgeon has now vowed to fight the next general election as a “de facto referendum” after being denied permission by London to hold another plebiscite.

This is desperation but the First Minister, more than eight years into her job, will have her eye on her legacy as much as on Scotland’s problems.

Her bid to destroy the North Sea oil and gas industry, outlined last week, is a concession to the Scottish Greens, who Sturgeon brought into government with the sole purpose of pursuing her separatist agenda.

And her determination to press ahead with gender recognition legislation, rushing her bill through the Scottish parliament before Christmas without sufficient scrutiny, shows she cares more for her image as a cutting-edge social reformer than for women’s rights.

Next week, Sunak will have to decide whether to block the Gender Recognition Reform Bill, on the grounds that it could have consequences for the UK Equality Act, especially in relation to the protection of single-sex spaces.

None of this – the attack on women, the threat to 200,000 oil jobs in the north-east, the long-term neglect of domestic responsibilities such as health – is in Scotland’s interests.

Imagine if the Scottish nationalists focused on issues of concern to the Scottish people, mused Penny Mordaunt, leader of the House of Commons and one of the few MPs to regularly nail the SNP.

“I wonder what would happen if they focus on, for example, the tragic situation of addiction in Scotland, which currently has the largest drug-related deaths anywhere in Europe and the largest alcohol-related deaths of anywhere in the UK,’ she said in the Commons this week.

It is not difficult to skewer Sturgeon for her record in government. She has squandered her years in power, prioritising the elusive goal of independence over the day-to-day slog of running the country.

In mounting his charm offensive in Scotland this week, Sunak spoke of wanting a ‘constructive dialogue’ with the Scottish government. But he has missed an opportunity.

Sturgeon doesn’t want a dialogue with Westminster, she wants an all-out war. For the sake of the Union, the PM should follow the lead of his more seasoned Scottish colleagues and take the fight to her.

Write to us with your comments to be considered for publication at letters@reaction.life