Even just a few years ago the answer to whether the NHS in Scotland needs independence to survive would have been an easy ‘no’. One may argue that independence may improve the NHS in Scotland, but I think most of us would have stopped short of suggesting a need for independence to ensure the very survival of the NHS. Now, though, that’s not so clear.
The first issue we need to be clear on is that Westminster currently has a greater say on the state of the NHS in Scotland than Holyrood. In times of adequate funding, Holyrood is the dominant force in how the NHS is run in Scotland. But now, in our current times of near zero population-adjusted growth in the UK national NHS budget, it is undoubtedly the UK Government that has more control of healthcare performance in Scotland.
The issue boils down to the rate-limiting factor for the public gaining access to healthcare. Currently, the rate-limitation is due to budgetary constraints. The healthcare needs of the population are growing, and the resources simply can’t keep up. We can’t recruit. We are unable to expand services to meet demand. NHS salaries have failed to align with the cost of living, leading to a loss of experienced personnel. In essence, NHS Scotland is being choked by the policy decisions made in Westminster.
NHS Scotland outperforms NHS England
Within this context, the Scottish Government has actually done quite well. The key metrics of doctor-to-patient, nurse-to-patient, and bed-to-patient ratios are all significantly better than elsewhere in the UK. NHS Scotland has maintained more capacity than NHS England.
Scotland has also outperformed England in relation to four-hour A&E waits (33% versus 41%) and time to access cancer treatment (72% versus 64% for under 62-day treatment waits). There were five times more patients (population-adjusted) waiting more than 12-hours in A&E in England than Scotland, and three times more children (population-adjusted) are waiting for healthcare in England than Scotland.
Devolution, it seems, has permitted some protection from the very different Tory-based NHS agenda.
The entire budget for all nations in the UK is determined by Westminster. It is the successive occupants of Nos 10 and 11 Downing Street who make the ultimate decision about how much of our collective resources are spent on the provision of healthcare across the UK. If the Scottish Government seeks to increase healthcare spending beyond what is decided by the UK Government it must raise the funds itself, which often means an increase in taxation – as the SNP has already done.
In this environment of severe UK-wide resource restrictions, and examining the data from Scotland, England and Wales, the Scottish Government has done a reasonably good job of protecting the NHS.
But, and we must be very clear on this, if we look at Scotland on its own, its health service is in trouble. Imagine, 28% of patients who are suspected of having cancer now must wait two months before they start treatment; every month, thousands still wait more than 12-hours in A&E; thousands of kids still wait months on waiting lists to access healthcare. Taking Scotland on its own and comparing it to similar countries outside the UK, the health service in Scotland is failing to provide the access to healthcare the population needs.
Despite the power of devolution and the power to raise taxes, the NHS in Scotland has fallen victim to the same catastrophic Conservative policies as the rest of the UK.
Any hope for the NHS under the Labour Party?
With the current Conservative government in freefall and the socialist Labour Party in ascension, there is some hope. Undoubtedly, a Labour government in power in Westminster is much better for the NHS in Scotland than a Conservative government remaining in power. We can expect to see some growth in NHS service provision. Indeed, just a year or so ago, Labour announced a policy to double the number of medical school places, which, in time, would lead to a doubling in UK-trained doctors available to begin careers in the NHS. While not explicitly stated, this is a policy to grow the NHS.
There are a few other Labour policies that also look promising. But, of late, the rhetoric from Labour is worrying. Labour now seems committed to using the private sector more. This looks to be a policy going forward despite no real investment in the health budget to support more private-sector activity.
One can only assume that such funds to outsource NHS clinical activity to the private sector must then come from the already wholly inadequate NHS budget (as is happening at pace in the NHS in England). In the absence of a significant boost to the healthcare budget, this move by Labour doesn’t add up. At least, it doesn’t add up if the primary intention is to work towards improving access to healthcare for the general public.
Compounding these concerns is the news that Labour MPs have accepted donations from numerous private healthcare companies. Yes, you read that right: an evolutionary socialist political party born from working-class people is accepting donations from private healthcare companies. It does, as it should, raise an eyebrow or two.
A commitment to expand the private healthcare footprint at the expense of the current woeful NHS budget, all while accepting donations from those very private healthcare companies who stand to benefit from this surge in public money contracts, kind of stinks. It would of course be different if the NHS recovery plan from Labour made sense.
If the use of the private sector was funded separately and went alongside a significant growth in the NHS budget, then it would be easier to accept the donations as simply private-interest lobbyists lobbying. Equally, if Labour had rejected the private healthcare donations, then the plan to use the private sector to get on top of the waiting list – while still nonsensical from a fiscal or clinical perspective – would at least only appear like an ill-conceived policy, and not a policy seemingly servicing the private-sector lobbyists.
Labour rhetoric policies – disappearing hope for NHS England survival
The NHS in England is in dire straits. Indeed, most on the inside believe the fight to keep the NHS core principle – equity in healthcare – has already been lost: the two-tier health system is already well established. A few even believe that it will be lost indefinitely. The NHS in England may soon exist in name only.
A Labour victory had offered some hope, but recent shifts in rhetoric, questionable policies, and even more dubious donations have led to some of that hope disappearing. The question of whether the NHS can recover, at least in the next few decades, is now not such an easy one to answer.
For those of us who have had direct contact with the soon-to-be secretary of health, Wes Streeting, the general impression is that he seems like a decent person who believes that working-class people should have access to decent healthcare. But there remains uncertainty as to how easily he can be influenced by the self-serving arguments of lobbyists.
The current Labour rhetoric suggests Streeting may well be malleable and easily allured by the promise of improved efficacy of using alternative models of healthcare provision, so long as there is an ‘assurance’ that treatment remains free at the point of care. I’m not sure his self-confessed frustration with the NHS will allow him to see the very basic truth of healthcare: the sole determiner of a successful universal healthcare service is resource allocation.
Will Streeting and the Labour Party fight to nurture and heal the broken and injured NHS? Or will he and Keir Starmer be lured into palliating the NHS based on the promise of more sunny-lit uplands? I honestly can’t tell.
There is still the possibility that Labour are using rhetoric to win an election and deep down they will – as previous Labour governments have – invest in the health of the nation and make the NHS great once again. But asking the general public to take this gamble with our universal access healthcare service, that has for decades provided one of the most cost-effective healthcare systems in the world, does seem to be asking rather a lot.
Argument for independence – If Scottish and Westminster Labour are too similar
Will a Labour government in Holyrood look to abolish free prescriptions? Will Labour allow private providers to charge for hospital parking? Will Labour look to redirect more NHS resources to the private sector? Will Labour renege on the current Scottish Government’s pledge to restore junior doctors pay to 2008 levels? Again, there is no reassurance within Labour’s current rhetoric that they won’t.
If then, we have no assurance from the only two political parties that have a chance of power in Westminster – Labour and Conservative – that NHS funding will be restored or that they will stop pushing the private healthcare agenda, is independence our best chance of protecting the Scottish NHS system?
On one hand, the SNP have managed to resist, to some degree, 14 years of Conservative efforts to bring in private providers – suggesting Holyrood maintains enough power to fulfil the Scottish peoples’ wishes of maintaining the NHS. On the other hand, 14 years of being at the will of the NHS policies in Westminster has ultimately led to a dramatically diminished NHS in Scotland – suggesting Holyrood has too little power to fulfil the will of the Scottish people regarding the NHS.
We probably have had enough power as a devolved nation to resist the Conservatives’ wilful attempt to turn a profit from our healthcare miseries. It still remains unclear if we were to have a Labour government both in Westminster and in Holyrood whether we would maintain a suitable distance from a UK Labour Party that may, unwittingly or not, sacrifice our National Health Service to the circling vulture capitalists.
Based purely on protecting the NHS, which is to say, protecting equal access to healthcare, and accounting for the current Labour Party direction, one can certainly see the argument for independence or at least maintaining a healthier distance from Westminster.
More on the NHS
