I have many reasons for voting Yes on 18 September but key among them is to protect the achievements of the NHS in Scotland and obtain the powers to improve the health and wellbeing of all our citizens.
Contrary to common perception, the NHS in Scotland has always had a degree of autonomy and since devolution in 1999 has been under the direct control of the Scottish Parliament. Since then, the system of competing hospital trusts, introduced by Margaret Thatcher and revisited as foundation hospitals by Tony Blair, has been abandoned in favour of collaboration and co-operation.
While the NHS in England is being privatised, it is NHS Scotland that has returned to the traditional philosophy of a unified, publicly funded service. However, Westminster maintains financial control of funding through the Scottish block grant and the Barnett formula, and can therefore still force change despite devolution.
Since devolution, all Holyrood regimes have prioritised Scotland’s specific health needs rather than just matching policy in England and Wales. The focus in Scotland in the early 2000s was tackling heart disease, cancer and mental health, with extra funding provided to encourage the redesign and improvement of services.
While the NHS in Scotland is far from perfect, there has been a focus on improving quality and safety over the last 15 years. The national patient safety initiative seeks to reduce dangerous errors through stronger team working and a more open approach to reporting incidents. Since 2000, quality standards have been set for the treatment of many common cancers, along with other aspects of NHS care, by Health Improvement Scotland.
The National Institute for Health and Care Excellence developed its own breast cancer standards in 2009 but, according to Breast Cancer Campaign, its implementation is not being audited. It has been told that, legally, it is up to the commissioning GPs to ensure the quality of care delivered by their local breast unit meets acceptable standards. It is this loss of co-operation that is causing most damage to the NHS in England, with hospitals in competition with private companies and each other for patients and money.
One of the most telling changes introduced by the 2012 Health and Social Care Act is that the secretary of state is no longer legally responsible for ensuring the provision of healthcare to every person in England and Wales. This is passed to commissioning groups of GPs and managers, who put services out to tender which are often awarded to private providers. Hospitals are now run as businesses and the job of managers is to consider the trust’s income rather than patient care. Patients with complex needs are expensive to treat and can find themselves excluded by some private providers and have difficulty accessing services.
The new NHS chief executive, Simon Stevens, used to work for the large US private health provider, United Health. His inaugural speech about the “misplaced consensus within the health service” and the “innovation value of new providers” would suggest that the provision of services by private companies will only increase, creating competition rather than collaboration between parts of the NHS.
As a significant amount of the budget is spent on the administration of these contracts, the money available to spend directly on patient care is reduced. Although patients don’t have to turn up with their credit cards (yet), the NHS in England will be unrecognisable within five years.
The Barnett formula (in the unlikely event that it survives a No vote) is based on the public spend of Westminster, so the money for NHS Scotland will decrease as less of the English NHS is provided by a public service. This, along with likely cuts to the overall block grant (£25 billion of cuts are planned after the next UK election), will make it harder for any Scottish government to protect the NHS here.
I see independence as our only chance to protect NHS Scotland from privatisation and to create a society where we value the life of each and every person. «
Dr Philippa Whitford is a consultant breast surgeon based at Crosshouse Hospital, Kilmarnock