I HAVE worked as a GP for 20 years in primary care. I believe the only reason that the NHS in Scotland has stayed true to its founding principles is that since 2007, Scotland’s government has reaffirmed its commitment to a publicly provided service with a focus on mutuality – both public and NHS staff as owners and partners not users and providers.
In other words, Scotland has rejected the marketing and privatisation of the health service that is happening in NHS England. We have defended our collective rights to receive health care irrespective of social class and ability to pay.
NHS England is currently being sold off, bit by bit, via legislation (Health and Social Care Act 2012) that has blown it open to the commercial market. At the same time this is presented as a measure designed to improve health outcomes and the delivery of health services. These changes are aligned with an international trade agreement known as the Transatlantic Trade and Investment Partnership (TTIP) and are destroying the fabric of the NHS. Many people do not yet see how our devolved health service in Scotland is already being undermined by Westminster promotion and support for the same private healthcare providers in Scotland. Devolution cannot fully protect the NHS. If there is a No vote, we may well be forced to follow in the steps of NHS England in the great big NHS sell-off.
GPs will have to either become commissioners or become employed by commissioning groups. They will find themselves in direct competition with each other and other external providers. But this also means that GP services can fail if the market changes or practices are faced with insurmountable financial challenges. There will be a “lucrative sell-off” to other providers. This almost certainly will not result in increased choice or control for patients.
The reality is that corporate (not patient) interests will drive health- care and there is evidence already of the breakdown of this process in NHS England that has resulted in cuts to staffing levels, poor accountability and lack of access to services in the community.
There are many pressure groups trying to shed light on the tactics of the UK government in its headlong rush to privatise the health service in England, but sadly, in my opinion, it is too late for them.
The greatest challenge to the provision of healthcare today is presented by an aging population with complex health needs, as health inequalities widen and budgets shrink. At the other end of the age spectrum is the challenge of providing the best possible start to our youngest patients and their families.
A robust NHS primary care system is the cornerstone to meeting our population’s healthcare needs, ensuring positive health outcomes and health equity.
We are not “better together” in this UK family because we do not have equal, independent voices, as any strong partnership must have. It is a dysfunctional family unit and Scotland is insecurely attached to Westminster politics. The consequences of insecure attachment have a negative effect on our long-term health, educational and economic potential. We must reject policies that are divisive and perpetuate the cycle of poor health outcomes linked to adverse life circumstances.
We now have a unique opportunity to follow a different path – promoting health and well-being in a health service that is itself in good health and aligned with other policies that have at their heart equity and fairness.
It is time for Scotland to get off the “naughty step” and step confidently into our independence. It is not a step into the unknown – we have years of experience and all the ingenuity needed to solve problems and address challenges.
There might be a few wobbly episodes but we will walk forwards stronger together in an independent Scotland, knowing that our publicly funded health service and economic strength will allow us to still provide universal health care that is free at the point of need. «
Dr Anne Mullin is a GP in Glasgow and a member of NHS for Yes