Scotland has had full responsibility through devolution for our Health Service since 1999. The result has been that the NHS here now looks substantially different from that in England, our approach being one of collaboration, cooperation and minimal use of the private sector. It has many unique features.
Some, such as the staff partnership, have been recognised by commentators like the King’s Fund as world leading. Others, like our managed care networks, could only develop effectively in a collaborative system and are beginning to deliver results. Our patient safety strategy is also world leading.
The challenge for the Yes Campaign is to explain what possible advantages there are to patients through independence? The Union provides many advantages which will be put at risk with independence and will over time I believe degrade our Union advantage.
The biggest challenge to Scotland’s current preeminence in health will come about indirectly. We have five medical schools. This is far more than would be required for an independent Scotland. Students from England pay tuition fees and it is very unlikely that this will be allowed under EU rules. The loss of income to Scottish Universities of fees has been estimated at £140 million. Over time the Crerar Report’s prediction that we would half our medical student intake could happen. This would mean two fewer medical schools.
The current situation within the UK is that Scotland punches substantially above its weight in medical research. In competitive research applications we win around 14% of the UK Medical Research Council’s (MRC) funding compared to a population-based share which would be 8.3%. The position is similar for UK medical charities like Welcome, the National Institute for Health Research (NIHR)and the 13 other research councils. Indeed it is uncertain that we would be eligible for any NIHR funding. Any delay in EU membership could interrupt Horizon 20/20 funding as well.
Of course the Nationalists will promise to match the research funding. But it is the competitive winning against the whole of the UK that is equally important in maintaining quality. The MRC stopped funding research in Eire three years after they gained independence.
Scotland has evolved already its own world-leading approach to medicines. But currently the larger UK Union has ‘clout’ in negotiations with the pharmaceutical industry. A smaller Scottish budget, whilst still significant, would inevitably have less influence.
There are also savings through size from the regulation of health professionals. Scotland has no guarantee that it would be able to retain the UK General Medical Council, the General Dental Council, the Nursing and Midwifery Council and the Health Professional Council. Costs are likely to increase from having to set up our own bodies in Scotland. On becoming independent, we would need our own regulatory body for medical devices (MRHA), Vaccines Advisory Committee and regulation of substances. This parallels concerns generally about setting up separate different and costly regulation.
There are also seventy UK wide disease registers which with their size is of great benefit in monitoring patient outcomes.
We already have our own separate institutions where these are useful like the Scottish Medicines Consortium and the Mental Welfare Commission
What has all this to do with patients? These underlying and unnecessary structural disruptions will lead to a parochialism and diminution of an integrated system which has built up over three hundred years of the most successful Union in the world with Scotland’s contribution to that union in medicine exceeding almost every other region.
We could lose medical schools. Our research base will certainly not get better and we could lose funding. We are likely to pay more for our medicines. We would pay more for registration and regulation of health professionals. We would still be able to access the NHS in England but it is very likely that the favourable terms arising from being part of the UK would not continue.
Scottish Health Boards would be charged full price for the 24,000 patients treated annually in England.
So why risk our preeminence within the UK? Scotland under devolution has all the powers we need to progress an NHS which is world leading. What would we gain from separation?
Dr Richard Simpson MSP is Scottish Labour’s Public Health spokesman.
This article first appeared in Healthier Scotland – The Journal Published by Socialist Health Association Scotland March 2014