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Response to insideMoray article ‘No Campaigner insists people in Moray are ‘wise’ to SNP claims on health‘
Dr Douglas Jarvie (address supplied)
In your ‘Inside Moray’ article (11/7/14), Sean Morton said that a Yes vote was ‘the real threat to the NHS’ whilst chiding us for ‘trying to scare people’. Respectfully, I would like to disagree entirely on these points. The opportunities for public health would be great indeed. As such, I felt that Mr Morton deserved a detailed response.
The NHS is very important – it catches us when we fall. However, more important than cure is prevention. One possibility with independence would be using public policy to give people a better start in life, a better standard of living, better housing.
The link between poverty and poor health is well known. Poorer children have more physical and psychological health issues. They tend to achieve less at school and tend to be more likely to smoke and drink excessively. They become poorer adults, with more chronic health issues and lower life expectancy. Tackle poverty – using currently reserved powers – and we will improve our long term health.
With power over employment law, we could set a fairer minimum wage, lifting people out of poverty. With control of benefits, we could end the JSA sanctions regime that means people could have no benefits for up to three years. How can you live with no money for 3 years?
Returning to the NHS, it is true that we have devolved operational control. Unfortunately, within the block grant, we have limited control on spending. Worse, spending cuts in England will directly impact on the grant.
In England, privatisation is advancing, with £16.6Bn of contracts agreed since the end of 2012, including cancer services worth over £1.2Bn. The Secretary of State for Health no longer has legal responsibility for providing clinical care in England, with ‘any qualified provider’ able to do so now.
This may have several unintended consequences. It could fragment collegiate working between health boards, with e.g. companies unwilling to work with competitors to improve rival services. It may affect training, with the NHS unable to provide exposure to techniques (such as minor surgical procedures) in which junior staff need to gain proficiency before advancing through their training.
Staff may be forced to switch from NHS to private employment, as no ‘NHS’ service exists to employ them. This will probably be on inferior terms and conditions – pay, pension, leave – as the company reduces costs to make profit – a company’s main motivation.
How does this affect us, given our devolved control? A main point of privatisation is to reduce costs – reducing overall budgets. This will impact on our block grant – In 2010/11, the Scottish Government had a grant of £30.7 Bn, reduced to 27.3Bn in 2014-15 – a cut of 11.2%. NHS spending went from £11.3 Bn (36.8%) to £12Bn (43.9%) in that period.
In the context of restriction to the block grant, such a dominance of spending on the NHS may not be sustainable – a choice will come as to whether we further squeeze other departments, reduce NHS spend, or both. Under devolution, we cannot change this.
Further implications are raised by The Tranatlantic Trade and Investment Partnership – a deal between the EU/US that will open up all manner of government services to private involvement. It would force NHS services open to private involvement unless (1) there is a state monopoly – with the UK being the state in this context, or (2) the UK Government exempts the NHS, which it has no apparent intention of doing. This could open Holyrood up to legal challenge – an argument which has not yet been tested, but which could be avoided with independence.
As to scaremongering: I advise Mr Morton remove the beam from his own campaign’s eye before instructing us on the mote in ours. It was Gordon Brown that told us that organ transplant cooperation would end, despite written confirmation from NHS Blood and Transplant (NHSBT) that it would not. Vote No Borders was caught lying about services at Great Ormond Street Hospital (GOSH).
Finally, it was regularly stated by Better Together that the ‘British NHS’ would be pulled apart by independence – most recently by Sam Galbraith. I am grateful that they now acknowledges that the Scottish NHS is one of 4 independent health services – one that already pays for cross-border services, such as provided by NHSBT and GOSH. The bureaucracy of cross-border care already exists and such arrangements are common worldwide.
With Scotland set to be the 14th richest nation (by GDP) and with finances which are as healthy, if not healthier, than the UK’s, we can afford to run our NHS if we were independent. More than that, we could change aspects of our society that lead to the poor health straining our system. With those powers, we could strive to shake of the “Sick Man of Europe” label once and for all.
I hope this addresses the points raised in the article.
Dr Douglas Jarvie (GP)