Frontline Service

The warning from Scotland’s Health Secretary, Alex Neil, was stark: “A No vote would put our health service at serious risk.”

In a statement to Parliament, Neil called a No vote a “disturbing prospect” for our NHS, adding that the consequence would be “reduced budgets as a result of privatisation, patient charges, fragmented pay arrangements for health staff, with further pay restrictions, and austerity as a matter of ideology south of the border.”

The rebuttals were swift, with Scottish Labour’s shadow health secretary, Neil Findlay, accusing the SNP of “lying” about the NHS to “scare the sick and the vulnerable to try and revive their faltering campaign.”

A month on and his feelings are just as strong, calling it “utterly desperate and pretty despicable.”

The recent claims about the health service, despite no mention of such concerns in the Scottish Government’s White Paper, ‘Your Scotland, Your Voice’, has been particularly galling for Findlay as he says that not two months ago, Alex Neil had invited all members of the opposition for a consensus-building meeting about the NHS and the challenges it faces.

“All of the opposition parties at that table said we will work with you in order to ensure that we have a health service fit for the 21st century. We all agreed with the 20:20 vision. And yet, despite the NHS not having been mentioned for two years, not one sentence mentioned about privatisation at that meeting, it suddenly becomes the biggest issue in the campaign,” he says.

“Now the goodwill there has been blown to smithereens by the Government and by the Yes campaign, and I think that is a great mistake.”

Instead of “playing politics” with the future of the health service, Findlay, who has called for a review of the NHS in Scotland, argues the Health Secretary should be focusing on the real and present pressures.

“Had Alex Neil been doing his day job rather than concentrating on the referendum then we would be looking at issues of how we prepare for winter, because there is an A&E crisis now, never mind in the winter. We would be dealing with waiting lists. We would be dealing with the ambulance service. We would be dealing with preparing the NHS for those demographic challenges.”
And counter to Yes campaign claims, Findlay argues that the biggest threat facing the NHS is actually the extra public spending cuts of up to £6bn – half of the entire NHS budget – that the Institute for Fiscal Studies has calculated an independent Scotland would face.

“How do we fund that [the NHS] if we are in a situation where we are cutting taxes and we’ve got a £6bn black hole, and we’ve got the EU deficit proposals and we’ve got a currency union, and we are attempting to gain credibility with the markets? How do you fund public services with those five or six pressures on you? I think it could be catastrophic,” he states.
However, Dr Willie Wilson, co-founder and chair of campaign group NHS for Yes, argues that the real threat to Scotland’s finances would be from a No vote and the next round of the UK Government’s austerity cuts.

“Although we’ve got legislative power to do things, you can’t do anything unless you have the money to do it. And it is absolutely clear that Mr Osborne is going to impose major cutbacks. He has said that the job is not half done. So what we’ve seen in the last four years is going to be applied even more stringently in the next Westminster Parliament.”

The problem for the Scottish Government, as he sees it, is that having sought to protect the NHS funding in Scotland through the last wave of cuts, the flexibility in the financial system has been exhausted.

“We have made these savings and the NHS gobbles up 40 per cent of our total block grant. So it really can’t be protected against another even bigger round of cuts. And when that protection fails then cutbacks are essential. And I suppose the Scottish Government would have to make some very bitter choices. Do we cut back on prescription charges? Take away free eye tests? Do we raise charges here, there and everywhere? There would have to be charges. There would also have to be cutbacks in staff and bed numbers.”

While he argues that it “seems likely” that charges such as for prescriptions and eye tests would have to be reintroduced in the event of a No vote, he doubts that even this would be enough.
“Prescription charges would be a relatively small way of saving money when the big cuts come. Eye tests, I think, are of the same order. But we are talking a few tens of millions here and the budget is projected for next year at almost £12bn. So these charges are chickenfeed. I think the biggest disaster would be in wages. They would just have to shed staff here, there and everywhere.”

Wilson, who established the campaign group a year ago as “a one man band”, believes the focus on the NHS is a winning argument so he’s pleased by the recent support from senior members of the Yes campaign.

“I laugh when I hear the other side accusing Alex Salmond of having introduced this. When I first went to the Yes Campaign and suggested this was a good line to take and what could we do about it, they were very hesitant. They didn’t like the negative angle of it, because there is a negative angle. But life has got lots of negative things in it as well as positive. And I just feel this is a very solid argument, no matter how negative you feel it is.”

In making these arguments, however, the Yes campaign has been accused of “scaremongering”.

And yet, Allyson Pollock, Professor of Public Health Policy and Research, Queen Mary, University of London, defends it of the charge, arguing that the threats are quite real.

“Why would Westminster want to continue to fund an NHS in Scotland when they have actually removed it in England,” she poses.

“It has been called the Abolition Act. It abolished the NHS. The Health and Social Care Act (2012) removed the fundamental rights and entitlements to healthcare and it has reduced the NHS to a funding stream and a logo. And the government is hell-bent on privatising and contracting everything out. So that immediately has implications for Scotland.

“First of all, it is a different type of rights, people in Scotland have a right to healthcare where people in England don’t. And secondly, there is going to be a lot less funding.”

However, Pollock, who trained in medicine in Scotland and set up and directed the Centre for International Public Health Policy at the University of Edinburgh from 2005-11, also expressed her disappointment that the SNP Scottish Government didn’t do more to challenge the Bill at the time it was progressing through Westminster.

“I really do think all the MSPs in Scotland should have said something. Because we are all interrelated. We all cross borders for work or to see relatives. There are very close ties. So this is like seeing a member of your family having their rights to healthcare removed. Scotland should have spoken out more and didn’t, and we are paying a price.”

Scots don’t understand the “scale of destruction” that is happening to public services south of the border, she warns, adding that people in England have had their right to healthcare removed by recent reforms to the health service.

“The problem is that people living in Scotland are in a cocoon. They are in a bubble. They don’t know the reality of what is going on in England, which is extraordinary decimation and destruction of the health service, but also schools, universities – everything. It is really quite scandalous what is happening in England. And the Scottish newspapers don’t report it because they think the people in Scotland aren’t interested. But they need to get interested before September 18th to understand the scale of destruction that is happening.”

With the polls neck and neck going into the final week, Better Together has been seeking to counter some of the claims with a video setting out the facts on health and independence, pointing out that as control of the NHS is devolved to the Scottish Parliament, all decisions in Scotland about the NHS are made in Scotland.
In a speech in Glasgow last week former Prime Minister, Gordon Brown sought to make the position of the unionist parties clear:

“With the powers we have and without separation, we can guarantee forever the future of the NHS in Scotland.

“As a universal service free at the point of need, which is what Scottish people want.”

What the people of Scotland want will at last be known this week,. We have a big decision to make. However, for Neil the choice is clear:

“In short, the people of Scotland have a choice between two futures: one in which this nation’s vast wealth can be marshalled to help to create a fairer society; and one in which the budgets that are available for Scotland’s public services are consigned to the whim of Westminster.

“Nye Bevan’s founding principles for the National Health Service were that the institution should be owned by the people and should give access to the highest attainable standard of health services, which would be free at the point of delivery and based on clinical need and not ability to pay.

“Those principles must be protected, and a Yes vote gives this nation a chance to do just that by framing a constitution that reflects the values and aspirations of our nation.”