The NHS is as much an important aspect of Scotland as it is the wider United Kingdom. Scotland has a long history of state funded healthcare, even before the creation of the NHS in 1948. In the early 1900s, Sir John Dewar led a review which created the Highlands and Islands Medical Service, a state-funded institution which aimed to address the poor health conditions in the north of Scotland, 35 years before the creation of the NHS. It provided health care for over 300,000 people across half of the total landmass of the country. After the end of the Second World War, it was transformed into the new Scottish National Health Service, a defining feature of post-war Britain. The establishment of a separate Scottish health service which was completely under Scotland’s authority is an interesting precursor to devolution, which would only pass around 50 years later.
How does Scotland’s NHS perform today?
Today, Scotland’s NHS is funded via devolved spending and managed by the Scottish Government. Healthcare spending per capita is over £500 higher in Scotland compared to England. Despite being part of the UK, whose health service has been hammered by the impacts of underfunding, Brexit and the COVID-19 pandemic, the Scottish NHS frequently outperforms its English and Welsh counterparts. Per 100,000 people, Scotland’s NHS possesses:
- 64 Whole Time Equivalent (WTE) GPs, compared to 48 in England and 50 in Wales
- 1,181 WTE nurses and midwives, versus just 610 in England
- 88 student nurses, around a third more than England’s average of 53
- 63 dentists, versus 43 in England and 46 in Wales
Despite criticism over high ambulance waiting times, Scotland still outperforms much of the UK. As of March 2023, 68% of all patients were seen and subsequently admitted, discharged or transferred in under four hours in Scottish Accident and Emergency departments. This is close to the Welsh NHS wait time statistic of 70% and significantly higher than the 56.8% waiting under four hours in England. This is also despite Scotland and England measuring waiting times differently until recently, making the disparity even more stark.
The Scottish system of education and training has also strengthened our health service. Scottish student nurses, midwives and paramedics in Scotland receive a bursary of £10,000 a year, double the UK average. Scottish students also accumulate the least student debt compared to their English and Welsh counterparts studying in other parts of the UK.
Scotland’s NHS is in danger of being sold off
Jeremy Hunt, the new Chancellor, has co-authored a book calling for NHS privatisation. Under his tenure as Health Secretary, A&E waiting times skyrocketed, while cancer referrals and vital operations targets were missed. Despite his weak attempts to blame patients, staff and immigrants for his failures, public dissatisfaction with the NHS, infant mortality and life expectancy all shot up during this time period. Hunt has since fallen upwards into one of the most powerful positions in the UK Government.
While Scotland has control over devolved healthcare policy, the UK Government still controls the purse strings. Cuts in funding have a real and tangible impact on both the provision of healthcare and the lives of people in Scotland. An investigation into the impact of austerity found that Tory cuts to the NHS lead to just under 20,000 excess deaths in Scotland between 2012 and 2019.
The threat doesn't just come from the Conservatives. Former Prime Minister Tony Blair has also come out in favour of expanding the private sector role in the NHS. With Labour leader Kier Starmer backtracking on several planned reforms, there is nothing to say that he would be a major change in direction for UK health policy.
Meanwhile, the UK’s new Internal Market Act would give Westminster the power to set up healthcare services and providers based on ‘market access principles’ without the consent of the Scottish Government. In theory, this bill is designed to make trade between the four nations that make up the UK easier after Brexit. In practice, it is a power grab that allows Westminster to bypass devolved legislation. Devolution alone cannot protect access to free health provision in Scotland. As long as the UK has control over budgeting and overall legislation, it has free reign to do whatever it wants.
In recent years, the NHS has been stretched to its limit. Underhanded PPE deals during the coronavirus pandemic show how the NHS is in danger of being ‘privatised by stealth’, while surveys conducted by the Royal College of nursing show that over half of nurses working in NHS hospitals are considering leaving their jobs. Brexit has also had an impact, with the removal of European healthcare staff from the NHS workforce causing shortages in key specialist areas, including paediatrics and psychiatry.
In a new paper published by the Scottish Government, protection of the Scottish NHS is incorporated into a plan for an independent Scottish constitution. Independence gives Scotland the chance to protect its NHS, which is as much its own institution as it is a British invention. With independence, we can give Holyrood the powers to improve, staff and fully fund healthcare properly and protect it from creeping Westminster privatisation for future generations.
We believe that independence offers Scotland the opportunity to be a better nation. A nation that more closely matches the values, hopes and aspirations of the people of Scotland.
As a sovereign independent people, we can truly protect Scotland’s NHS and our nations wellbeing. Independence offers us the chance to create a society and an economy that are more resilient, fairer, equal, ambitious, internationally connected, environmentally sustainable and successful.
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