In the 667 pages of the Scottish Government’s white paper, ‘Scotland’s Future’, a mere sixteen are dedicated to ‘Health, Social Care and the NHS’. The future of the NHS in Scotland, became a key battle-ground in the middle of August.
Nationalist claims of privatisation and funding cuts to our National Health Service if Scotland remains in the UK have polarised the country. I’ll argue that in fact it is unnecessary and wrong for health and especially public health to be so cheaply politicised in this way.
Firstly, the Scottish Parliament’s devolved powers have acted as a bulwark against Westminster reforms. The White paper itself states, “The advantages of making decisions for ourselves are clear”, while asserting that, “without devolution, the NHS would have been repeatedly reorganised by the Westminster Government of the day, regardless of the needs of the people of Scotland.” It gets perceptibly excited on the benefits of devolution to health. Threats to our NHS are mere shadows of a midnight bogeyman on the nationalist bedroom wall.
Westminster has not sought to impose its reforming zeal on Scotland, Holyrood has held to traditionally collaborative models of healthcare planning and delivery. Arguably it is too traditional in its hesitance to follow England’s example by breaking down hierarchies in favour of patient and community voices. Indeed, ‘divergence’ best marks health policy in Scotland vis a vis England’s. True, not only since the Coalition took power in Westminster in 2010, but throughout devolution’s short history under different political leaderships since 1999. Alex Salmond himself has said that nobody can force Scotland to privatise its health service.
That full control over health is a good news story is universally recognised. Health colleagues south of the border share the view, envious of the stability NHS Scotland enjoys. Although the White paper intention is to maintain UK links, it would be retrograde were independence to diminish shared learning, advice and regulation across the UK.
Innovation and economy of scale within the UK’s NHS framework are not accidental. A UK-wide NHS with both formal and informal networks, is ranked as amongst the best in the world. By disrupting these bonds, the SNP’s ambitions would create further fragmentation and uncertainty for the NHS
The SNP case
On health, however, some jaggy nettles have to be grasped.
The Barnett Formula, warns the SNP, is a vehicle not only for Westminster hand-outs to a cap-in-hand Scotland, but a Trojan horse of funding cuts and privatisation. First flaw in that argument is that Barnett applies not to the bloc grant, but only to ‘consequentials’: ie, changes over and above the annual health allocation (1).
Secondly, NHS funding has increased annually in England, matched under Barnett by increased funding to Scotland. The SNP Government failed to pass on these increases, choosing instead to apply the money to its own populist agenda. Indeed, to balance the books, they steadily increase use of private health care within our NHS. All without blushing.
The SNP Government seeks “the economic and fiscal levers currently controlled by Westminster, to set policy to Scotland’s circumstances, strengths and preferences.” In its wisdom, the Scotland Act 1999 legislates for tax varying powers. They have never been used. Instead, a costly and divisive referendum has set the clock ticking towards substantial public service funding gaps (IFS).
Hoping to trump all, the SNP includes a right to healthcare in its draft Constitution (2). But existing human rights law already entrenches such provisions, bolstered by legislation establishing and defining the NHS. An intention to build the NHS into the foundations of an independent Scotland, though laudable in its intention, is unnecessary and would become a happy hunting ground for legal challenge.
In summary, privatisation can happen only by the decision of our Holyrood Parliament. And right now no party there has any such intention.
The real challenges.
Inequality is the root of Scotland’s poor health and well-being. The SNP damns the obscenity of poverty in a nation so rich, a sense of affront shared by us all. Inequality is ingrained in a complex mix of social, cultural and economic factors. Reference is often made to the ‘Glasgow effect’, best illustrated in the very different life expectancies of boys from affluent Lenzie (82) and, just seven miles away, deprived Calton (54).
Nationalists fail to spell out how their independence project can even begin to improve a situation, which has baffled our best-laid schemes for over half a century. Nationalists might rage against the machine, but ingrained poverty is best tackled in unison with cities across the UK.
For inequality to be tackled, Scotland must build on successes like tobacco controls, reduced cancer mortality rates, or the promise of minimum alcohol-unit pricing. A more crowded and competitive independent government portfolio, however, would be hard pressed significantly to progress the health agenda in Scotland.
Research and healthcare innovation, in which Scotland’s Universities excel, receive 13% of all funding, a proportionately high level for Scotland’s 8% of the UK’s population. Why erode such an advantage to the health and well-being of Scotland’s people for the sake of political vanity? Let’s develop our distinctive education system and research strengths within rather than separate from, the UK.
Under our Parliament’s devolved powers, health has improved with prospect of longer-term benefits. Independence is not the logical next step. Instead of using health as a ping-pong ball, cooperation and sharing our strengths and talents within an interdependent UK is the way forward.