The No campaign likes to make great play of popular UK institutions like the NHS, and to imply that they’ll be lost or damaged in the event of a Yes vote. But something that a surprising number of people don’t know is that there is not, and has never been, any such thing as a “UK NHS”.
What we call “the NHS” was created in 1948, after three different Acts of Parliament in 1946, 1947 and 1948, as three separate entities - NHS England and Wales, NHS Scotland and Health and Social Care in Northern Ireland (HSCNI). Since the very first day of their existence, they were all completely independent of each other.
The text of the National Health Service Act 1946, for example, refers explicitly to:
“the establishment in England and Wales of a comprehensive health service”
NHS England and NHS Wales were divided into two independent organisations in 1969, and the Welsh service is now controlled by the Welsh Assembly.
Northern Ireland’s healthcare service, HSCNI, is not only separate from the others but is a different TYPE of service. As the name suggests - and unlike the Scottish, English and Welsh services - it deals with not only healthcare but social care, which in the other three countries is handled by local authorities.
That most people believe there’s a single UK NHS is in fact a testament to how well the four organisations work together. All the complexities of cross-border co-operation and service are largely invisible to patients.
Nevertheless, they ARE totally separate. Whatever you may have been told, Scottish people have no legal right to be treated in English, Welsh or Irish hospitals. Any treatment given to Scottish patients in other parts of the UK (and vice versa) is essentially private, except that the bill is picked up by the Scottish NHS and paid to the English hospital as a commercial transaction.
What this means is that the NHS will be completely unaffected by Scottish independence, because it’s already four completely independent services. NHS Scotland is already funded and controlled by the Scottish Government, and all of the necessary bureaucracy and infrastructure that lets it work with the other UK health services is already in place and has been in constant use for almost 70 years.
In the event of a Yes vote, absolutely none of that will have changed, and the service will continue just as it does now.
That’s not an assertion, but a simple statement of fact. When the anti-independence campaign group “Vote No Borders” ran a cinema advertisement in May suggesting that hospitals like Great Ormond Street would no longer treat Scottish children, the hospital issued an angry denial, saying the ad was “very misleading” and demanding that it be pulled. (Which it was.)
Similarly, when Gordon Brown alleged in July 2014 that independence would end cross-border organ transplants and blood transfusions , NHS Blood & Transplant were quick to issue an unequivocal and categorical assurance that it Mr Brown’s allegations were false:
“I can confirm that Scottish independence will not affect organ donation and the system will continue as it does currently.”
(Numerous Scottish newspapers and media outlets reported the original scare story. Not a single one bothered to report the correction.)
In the event of a No vote, however, things will be very different. The NHS in England is being rapidly privatised. In June 2014, the UK health minister Janet Ellison was secretly recorded telling a Conservative policy group:
“I don’t know how much any of you realise that with the Lansley act we pretty much gave away control of the NHS, which means that the thing that most people talk about in terms of health [the NHS]… we have some important strategic mechanisms but we don’t really have day-to-day control.”
Talking about the same Act (the “Lansley act”, whose proper name is the Health and Social Care Act 2012), Labour’s shadow health secretary Andy Burnham told the Independent newspaper in January 2014 that:
“Privatisation of the health service [is] the ‘core purpose’ of the Health and Social Care Act. Dragging the NHS down that path will destroy it, it will devour what’s precious about the NHS.
All the legal advice I am getting says, while we will just about be able to pull it back at the 2015 election, after that, it will be gone.”
The former Chief Medical Officer for Scotland, Sir Harry Burns, told BBC Scotland in July 2014 that independence would be “very positive” for Scottish health, and that:
“At the moment, decisions - particularly about the health service - being made in England are very different from the decisions being made in Scotland. That is very important because I fear for the way the health service is going in England.”
But if the English and Scottish health services are completely separate, why does the privatisation and destruction of the English NHS matter to Scotland?
It matters because the Scottish budget is calculated as a percentage of government spending in England. If/when the NHS in England were to be fully privatised, its current annual budget of almost £100 billion will cease to trigger a corresponding “Barnett Formula” payment to Scotland, removing approximately £10.2 billion a year from the Scottish block grant.
That’s almost all of the annual £11.9bn budget of NHS Scotland. It’s more than a third of the entire Scottish Government budget of £30bn, and vastly more than Holyrood could ever save by cutting other services.
Even partial privatisation of NHS England would strip billions of pounds from the Scottish budget. But there’s another aspect of the danger from privatisation of the NHS in England too. It was explained by Iain Macwhirter in the Herald in July 2014:
“The Transatlantic Trade and Investment Partnership (TTIP) is the fruit of long-running negotiations between the EU and the US over trade liberalisation. One of its fundamental principles is that services, including state services, should be open to private competition from American multinationals.
According to Garcia Bercero, the EU Commission official with responsibility for TTIP, health services in Europe will be opened to private competition, but only where privatisation is already established. In other words, where there is an existing state monopoly, foreign companies cannot sue the government in question for unfair competition.
But the UK Health and Social Care Act opened the UK system to TTIP because it explicitly introduces a private market in health provision in England. After a No vote, private providers and insurance companies may argue that, since Scotland is not a sovereign state but a region of the UK, it cannot be exempted from competition for health provision.”
So even though the UK’s four healthcare services are already completely independent, there’s absolutely no possibility that the Scottish NHS could survive the full or substantial part-privatisation of the English one if Scotland was still part of the UK.
But an independent Scotland with full control of its own revenues, rather than a devolved one reliant on a grant from Westminster, can protect the Scottish NHS no matter what happens elsewhere.