Lesley Riddoch: Hands up for a healthier Scotland

Scotland spends just 0.8 per cent of its budget on private providers, whereas Englands bill is now over 10 bn. Picture: Greg Macvean

Alex Salmond will announce a new Declaration of Arbroath today, pledging to protect the NHS from privatisation and create a fairer society. Is that a “cynical ruse” to win votes in a narrowing referendum race or just clear, unambiguous recognition of the widening gap between the Scottish and English health systems?

For most voters it’s hard to know how different the two systems have become. Newspaper scare stories suggest Scottish patients would be unable to access specialist facilities across the Border after independence. In fact, since Scotland controls most health spending, cross-border health contracts have quietly been happening for years without fuss. Independence would simply mean more of the same.

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It’s the NHS in England that’s being slowly changed and last week Labour’s shadow health secretary Andy Burnham called for a moratorium on NHS privatisation saying: “Commissioners [in England] have been ordered to put all services out to the market and NHS spending on private and other providers has gone through the £10 billion barrier for the first time. When did the British public ever give their consent for this?”

In fact, the coalition government’s Health & Social Care Bill, 2013, imposed a duty on CCGs (Clinical commissioning groups) to put all contracts for NHS services in England out to tender. A recent poll showed almost a third had already done so for fear of legal action, and the biggest outsourcing deal in NHS history looks set to happen in Staffordshire if cancer care is privatised in a £1.2bn contract.

Dozens of cataract patients suffered complications after receiving private treatment in an English hospital, leaving the NHS with a compensation bill. Doncaster care workers have been on strike over pay cuts after a private company took over NHS services there, and NHS nurse Kathryn Anderson made headlines when she attacked Danny Alexander over pay, asking: “How do you explain the NHS pay freeze which you intend to push out for a further two years when you and your MP friends are receiving an 11 per cent pay rise?”

The Scottish Government is the only government in the UK to have accepted the Pay Review Body’s recommendations in full.

This is how different the health service has become. South of the Border Department of Health figures show 6 per cent of the NHS budget is spent in the private sector – in Scotland that figure in 2012-13 was 0.8 per cent.

Ordinary doctors and nurses in England have been so shocked by the changes to the founding principles of the NHS they created their own political party – National Health Action (NHA). According to founding members Dr Clive Peedell and Dr Richard Taylor: “We warned the Health & Social Care Act would destroy the NHS as an effective, efficient health system fair to all citizens and patients. Now [it] is in force, we have seen how it is transforming a cost-effective public system of health care into one that is more expensive, wasteful and unequal, whilst worsening patient care and public trust.

“The NHS was more than just a structure for the delivery of healthcare. It was also a social institution that reflected national solidarity, expressed the values of equity and universalism, and institutionalised the duty of government to care for all in society. The NHS marked out a space in society where the dictates of commerce and the market were held in check. Thus the NHS became the glue that holds together the social fabric of our nation.”

That “social glue” is now, quite consciously, being diluted and even discarded south of the Border – and not just in the field of health. This wider point about equity, universalism and social fabric is the most important for Scots. Funding for the Scottish health service is unlikely to be seriously reduced by further privatisation in England.

But the market-driven, competitive philosophy that underpins these NHS changes is the same philosophy that underpins policy in non-devolved areas like welfare and the economy. And here too government policy is proving disastrous.

The National Audit Office has criticised Iain Duncan Smith’s Work Programme, the UK Statistics Authority has attacked his use of statistics, and the Major Projects Authority has given the Universal Credit system an amber/red warning. Government figures show 5 per cent of claimants moved as a result of the Bedroom tax – 95 per cent simply suffered a dramatic loss in income, sending them to loan sharks and food banks.

The Tories welfare “reforms” are a mess – but still they plough on, punishing the poor, dividing society and harming lives in Scotland as well as the rest of the UK.

But health and welfare are about more than hospitals and benefits. As the former chief medical officer Harry Burns observed, wellbeing results from being in control, living a life that matters, having respect and recognition.

All research suggests better public health arises from greater equality and a dramatic move in all health and social policy – from top-down towards bottom up, from professional-delivery towards self-direction, from “take-it-or-leave-it” diktats of remote bureaucracies towards flexible services delivered by grassroots communities. Britain – under the dead weight of English conservatism – has become a hopelessly elitist society whose damaging views can only partly be mitigated by devolution. But Scotland is finally moving in the right direction.

Last week Cosla’s Commission on Strengthening Local Democracy called for an overhaul of our councils – currently the largest and most remote in Europe. Last month, the Land Reform Review Group called for an upper limit on land holdings, the imposition of business rates on sporting estates, an end to primogeniture and a right to buy for agricultural tenants.

Is it a coincidence that the prospect of a fresh constitutional start has prompted such a flurry of fresh thinking about long-standing structural inequalities? I think not.

Scottish politicians have long had powers but lacked the political will to use them – fearing perhaps that a doubtful, timorous, dependent public might not support the concerted change needed to modernise our society.

Now though, it’s increasingly obvious that Scotland has a distinct political culture to develop and a choice to make.

The next step is to turn the tiller away from Britain’s current market-dictated course towards the North European social democracies which manage to combine Triple A credit ratings with top places in the Unicef Child Wellbeing Index every year. Nothing less will transform Scotland’s record as the Sick Man and Woman of Europe. The choice is ours.