The consequences of a No vote in September’s independence referendum can be envisaged no more sharply than through the lens of the NHS in Scotland.
Our health service is devolved and over the last twenty years it has diverged markedly from the its equivalent south of the border. The privatisation process in England started under Thatcher, accelerated under Blair and is now proceeding on an industrial scale, after stumbling through three series of very expensive reforms. The recent report of companies chasing contracts worth £689 million for cancer care and £535 million for end-of-life care gives an idea of what is happening to the English NHS.
NHS for Yes is one of the big sectoral groups of the Referendum campaign. It was launched only a few weeks ago and has already more than 200 members from among those working at all levels, both within and around NHS Scotland. I think I can safely say that every one of them realises that a No vote will carry a very high risk that privatisation would rapidly creep into NHS Scotland. The private sector has been used to catch up with some of the waiting lists that had accumulated a few years ago but there is absolute determination by the Scottish Government to keep private health provision in Scotland to a very minimum (well under one per cent of total expenditure). However, political devolution is not enough to guarantee that NHS Scotland will survive in its present form.
Indeed, if we do not claim our independence in September 2014, Scotland will very likely be forced down the route of privatisation and commercialisation, as is happening right now in England and Wales. Seven in 10 of the recent contracts awarded there (totalling billions of pounds) have gone to private healthcare companies such as Atos, Capita, G4S, Shire and Virgin. In a few years, NHS will just be a brand name in England and Wales. Since Scotland's block grant is proportional (on a population basis) to state funding of public services in England, by virtue of the Barnett formula, privatisation would happen largely for economic reasons, if we fail to vote for independence.
Our NHS takes up 40 per cent of our block grant, so the further huge austerity cuts promised by Chancellor Osborne after 2015 (and supported by London Labour) will mean we'll be forced to privatise NHS Scotland. The Scottish Government has so far protected our NHS from the cutbacks which have been imposed over the last four years by saving in other areas of expenditure. However, we are told that the austerity cuts still to come will be greater than those endured so far, so there will be little further flexibility in the Scottish budget after 2015.
Expenditure on health by its very nature demands greater-than-inflation increases each year, in order that new technology and treatments can be introduced. Thus the major cuts we are faced with will devastate our NHS and leave little alternative to opening the doors and letting the commercial wolves in. The recent publicity about the TTIP agreement being negotiated between the EU and USA should ring further alarm bells since it would give US healthcare companies the right to sue the Government if they are not allowed to compete for all contracts in the UK, including Scotland.
Privatisation in England has not been a success so far, according to its retiring head, Sir David Nicholson. His replacement has come from a large American private healthcare company, clearly indicating that the Westminster Government is determined to continue the process anyway. Prescription charges keep increasing every year and “self-funding” (for those who can afford to jump the queue) is encouraged. The Health and Social Care Act of 2012 has made competition and commercialisation mandatory. The process involves the NHS at all levels: a recent report spoke of 96 GP surgeries which are threatened with closure because they were “losing money”.
While in a sense this should be of no concern to us in Scotland, we do become involved if England in due course saves money by privatising their NHS since this would further reduce our block grant. In addition to these economic factors, there are political reasons to fear that our NHS will go down the privatisation route. The Westminster Coalition easily passed the Health and Social Care Act – a very clear example of how far Scottish and English politics have diverged. The passage of the Act was no doubt aided by the fact that well over 200 MPs and Lords held directorships, consultancies or shares in healthcare companies.
Scotland need not pray for a Labour victory in 2015 to protect our NHS. Andy Burnham, Labour's Westminster Health spokesman, has stated he wants NHS policies throughout the UK to be “consistent”.
NHS for Yes will continue to campaign to protect our national treasure, both for the sake of its 158,000 workers and for the benefit of everyone in Scotland who needs or will need health services free at the point of need.
This is the full submitted text of an article published in edited form in The Sunday Times.
* More on Scottish independence from Ekklesia: http://www.ekklesia.co.uk/scottishindependence
© Willie Wilson is co-founder of NHS for YES, the pro-Scottish independence group. He taught pharmacology at the medical and dental schools of Glasgow University until retirement. He remains owner/partner of a community pharmacy business in Glasgow.