POLITICS An independent Yes W By Dr Ian McKee on behalf of the Yes campaign


HEN forecasting how the health service will develop in an independent Scotland there is an


important caveat. T e vote in September’s referendum will determine solely whether Scotland becomes an independent country – how the country develops thereaſt er will depend on the political nature of the government which will be elected two years later. However, there are some useful clues.


Since the responsibility for health was devolved in 1999, signifi cant diff erences have emerged between the way that the NHS is run on diff erent sides of the border. In England and Wales the patient is seen as a customer and health providers are encouraged to compete with each other for business. Within the last year there has been a huge expansion in the role of the private sector in healthcare and this is likely to continue. In Scotland, on the other


right wing it seems reasonable to argue that these trends will continue. T e No campaign might argue that as


this has all happened under devolution, there is no need for independence to develop further a health service sensitive to the particular needs of Scotland. T is stance ignores two important points. T e fi rst is that the level of allocation of funds to Scotland under the Barnett Formula is under sustained attack from Westminster. It is a fair assumption that nothing has been done until now to alter this allocation because of the coming referendum. If there isn’t a Yes vote this reason will disappear and Scotland will face a large net reduction in income in coming years.


In an independent Scotland doctors and


“It is just possible that a central regulatory body might promulgate a policy that is not suited to the needs of Scotland...”


hand, patients are regarded more as partners. Aſt er all, as taxpayers they do own the service. Instead of competition the emphasis here is much more on collaboration – not only with fellow clinicians but also with the health department. T e general view in Scotland seems to be that the time, eff ort and legal expenses incurred by would-be providers fi ghting each other would be far better spent directly on patient care. More recently the aim of a service free to all at time of need has been expanded to include free prescriptions. Unless the fi rst government of an independent Scotland is unexpectedly


10 T e second is that the Barnett Formula,


or its successor, distributes funding according to public expenditure. As England massively increases funding for health and education from private sources, including patient charges and university tuition fees, the amount of public expenditure correspondingly decreases and with it Scotland’s share. Whether we like it or not we will be faced with the choice of having either a grossly under-funded health service or one in which rationing, patient charges and private healthcare rapidly come to the fore unless we take our future in our own hands and vote Yes next September.


dentists will be part of a health service in which professionals are expected to work together rather than against each other in competing provider units. T is is far more rewarding and involves much less bureaucracy. Under European freedom of movement legislation doctors are free to cross borders and practise elsewhere so it would be foolish of any Scottish government to create working conditions which encouraged large scale medical emigration to England or elsewhere. T ere will always be scope for private practice for those who wish it but the driver must not be a failing public service. Both the GP and consultant contracts need to be altered to allow for the rural nature of much of Scotland and the health inequalities in our main cities. One size certainly does not fi t all. Institutions such as the Scottish


Medicines Consortium and NICE already work amicably together


and there is no reason why this level of co-operation should not continue and develop between these and other regulatory and professional bodies aſt er independence. Of course it is just possible that a central regulatory body might promulgate a policy that is not suited to the needs of Scotland and in this case an independent Scottish Government is an additional safeguard.


n Dr Ian McKee is a former Member of the Scottish Parliament for the Lothians region. He was a partner in an Edinburgh medical practice and served in the RAF as a medical offi cer


SUMMONS


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24