I genuinely didn't know that the following exchange apparently represents a common belief:
"Poster 1: Wow f***ing wee, Do you really think there will be a national health service in an Independent Scotland?
Dont be f***ing stupid.
Poster 2: Why would there not be?
I don't think the Scottish people would have it any other way.
Poster 3: I think we'd struggle to cover all the public spending required.
If we really wanted an NHS, some other part of the public sector would have to go bye bye."
The answer to all of this is unbelievably simple, straightforward and objectively verifiable: we already have a separate, independent NHS Scotland, comprising our various local Health Boards, and we are already paying for it. NHS Scotland already administers to Scottish patients, each ascribed and identified by means of a Community Health Index, or "CHI", Number. We already cover the cost of this system of health care provision. The Scottish Government has done that, within the terms of its balanced budget, since devolution was introduced. Could it be simpler? We know we can have it and pay for it because we already have it and are already paying for it, from our own resources.
We've had a separate, independent NHS Scotland since the four national Health Services were created in 1948. The confusion is no doubt partly one of semantics. We're used to the fact that when people say "the Football Association" they mean the English Football Association. We've heard of the separate SFA and understand that there's a difference between it and the FA. What we maybe don't know is that the same kind of thing is true as regards the "NHS". The "National Health Service" is in fact the official name for the English NHS. We have our own, separate NHS and for us in Scotland that's what we mean when we talk about the NHS. It's just that it is officially called NHS Scotland. So, there is no single UK-wide NHS that an independent Scotland would lose and would have to replicate from scratch. We already have it in place and can afford to pay for it. We are paying for it now.
And this is what answers a new line, relying on our understandable confusion, recently tried by Better Together that was an absolute paradigm of their methodology: spin, sow doubt, move on swiftly before there's a chance of rebuttal. The various NHS bodies each on occasion pay for treatment provided by others: NHS Scotland will pay for Scots to have treatment in England and vice versa. Tom Greatrex, Labour MP for Rutherglen and Hamilton West, said that in 2012 43,573 Scottish patients were treated "using the NHS in England." Notice the weasel words: "the NHS in England". Brilliantly, brilliantly clever stuff. Because that's of course factually correct. But. It's just that it suggests there's only one UK-wide NHS which provides treatment to some Scots in England, free of charge to the patient at the point of use, in a way that it wouldn't do were we to become independent. In fact, of course, "the NHS in England" is the (wholly separate) English NHS and it makes money by selling services to patients from various other countries, including Scotland. Just as NHS Scotland makes money selling services to the English NHS. So, the English NHS will have treated some Scottish patients because we paid them to do so. That system would be entirely unaffected by our independence. NHS Scotland would fund the treatment exactly as it does currently.
But the real mischief comes from the following: "These figures indicate the substantial and increasing dependency of the NHS in Scotland on specialist services provided through the NHS in England."
How many hot buttons does that little sentence press? We're too small to look after ourselves. We're "dependent" on the NHS in England. Wrong. Quite, quite knowingly and deliberately false. On the contrary. We have a nationally funded Scottish Health Service that has the resources, provided by our tax base, to buy expertise from elsewhere, where approriate, just as it can, where appropriate, sell its own skillls to others. EU directives protect access to cross-border treatment throughout the EU and the various UK Health Services have arrangements with many other countries outside Europe, including Armenia, Australia, Israel, New Zealand and Russia. Why would the NHS in England want to stop selling its services to an independent Scotland, solely among all the countries in the world?
There's an illustrative story from one mother of how easily her son was provided with treatment by NHS Scotland in Scotland, England and Germany. A practising GP has explained how Better Together are simply engaging in the trademark scaremongering. But there's a difference here, I think. We're talking about the health and, possibly, lives of people, many of whom are going to be worried beyond our imagining. To foster, quite consciously and cynically for political gain, worries amongst that sector of the population, above all, is really breathtakingly repugnant.
See:
- Will we be able to afford to run the health service?
- What about the NHS's cross-border arrangements?
- Scotland's got what it takes to be independent
- Scotland's Economy: the case for independence (download as a single pdf here)
Update: 24 May 2014
In light of the cinema advert apparently being run by the weird, creepy, sinister "Vote No Borders", see in particular Wings Over Scotland's summary here:
"As we’ve pointed out many times on this site, the NHS has NEVER, not for a single solitary day of its existence, been a UK-wide entity. Healthcare in the UK is handled by four entirely separate, entirely independent organisations: NHS Scotland, NHS England, NHS Wales and Health and Social Care in Northern Ireland (HSCNI)"
| Photo © copyright Lisa Jarvis and licensed for reuse under this Creative Commons Licence |
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