Two opposing views on the health and social benefi ts of Scottish independence I I


N November of 2013 the Scottish Government published its 670-page white paper setting out the case for an independent Scotland and kicking off


what promises to be a bruising campaign in the run-up to the referendum in September of this year. Summons asked the opposing camps in the debate to off er views on the implications of Scottish


independence for health and social care. We posed three basic questions. Why would the health service be better (or not) under independence? Why should doctors and dentists vote for or against independence? What about cross-border working and professional regulation in an independent Scotland? Here are the replies.


No


Dr Susan Bowie on behalf of Better Together


T IS now under 9 months until we will make the biggest political decision of our lives: whether to remain a part of


the UK or whether to go it alone. T e question isn’t whether Scotland could be an independent country; it is a question about what is best for us, our colleagues, friends, our families and mostly our patients, the poor and the vulnerable. In Scotland today we have the


best of both worlds – a successful Scottish Parliament with full powers over our schools and our own NHS. We also have the strength and security that comes with being a part of something bigger. As a doctor, I am really proud to be


that within 20 years transformed medical services to the area and this acted as a working blueprint for the NHS in Scotland. Indeed, the fact that Scotland has been


able to make some radically diff erent choices from England regarding healthcare has shown the great strength


straightforward, internal relationship with an international, cross-border one. Being part of a larger UK allows us to pool and share our resources for the benefi t of all. Pensions too are an example of where


“ Our NHS currently doesn’t recognise borders but separation could put that at risk”


both part of and a product of the NHS. I was born only because of it, trained by it, worked for it for 35 years and have been saved by it. I take great exception to anyone or anything that might jeopardise it. Although the NHS is a uniquely


British institution, treasured by people across our islands, right from the start the NHS in Scotland has tailored its care to local needs. T e year 2012 marked the centenary of the publication of the Report of the Highlands and Islands Medical Service Committee or the Dewar Report. T e report presented a vivid description of the social landscape of the time and highlighted the desperate state of medical provision to the rural population in the Highlands and islands. T e report recommended setting up a new, centrally planned provision of care


WINTER 2014


of diversity within the Union and devolution process. But being a part of a Union means we also have access to world class centres of excellence across the UK should we need them. When a patient from Aberdeen travels to the world-leading Freeman Hospital in Newcastle they receive the same quality care that they would if from Aberystwyth. In training we also have the best of all worlds – the fl exibility to train anywhere from inner city London to rural Stornoway. What would happen to this mobility and fl exibility in a separate Scotland? What would independence mean for


doctors in training? How would leaving the UK aff ect our relationship with the BMA, the GMC and our defence unions? At this stage with 9 months to go, does anyone really know? Our NHS currently doesn’t recognise


borders but separation could put that at risk. We would be replacing a


being part of the UK benefi ts us all. Right now, across the UK, we pay into the state pension and we all benefi t on retirement. Given Scotland’s population is ageing faster than the rest of the UK, it makes much more sense to spread the costs associated with caring for an increasing elderly population across 60 million people


rather than 5 million. One of my biggest worries and that of


colleagues I’ve spoken to is what will happen to our NHS pensions under independence. Having done all those years on-call I was pretty secure in the knowledge of a very decent NHS pension (even with the proposed changes). However, no one at this late stage can make any promises about what will happen to my pension in a separate Scotland – what I will be paid or even in what currency. To vote for independence with all the


uncertainty that brings would be a leap in the dark. Even aſt er reading the Nationalist White Paper, I fi nd there are just too many unanswered questions regarding health and social care. Today Scotland has the best of both worlds. Why put that at risk?


n Susan Bowie is a GP in Shetland with 35 years’ experience working in the NHS


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