Free access to a Scottish National Health Service would be a priority for many if Scotland were to become independent. Events in recent years have shown that remaining part of the Union is no guarantee of free access to the NHS.
Independence may be the only way to guarantee access to a free, reliable public health service in Scotland.
- The past several UK Governments inflicted a ten year period of austerity - the longest in the 75-year history of the National Health Service, leaving public health seriously underfunded and vulnerable at the beginning of the COVID-19 pandemic.
While Scotland has control over devolved healthcare policy, the UK Government is responsible for allocating the overall funds. Westminster decisions to limit health spending in England can negatively impact the public finances available to the Scottish Government.
- 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.
- While Holyrood has a set (and limited) budget, it does not have to allocate the spending to match England’s. The Scottish Government has committed to additional health resources and services such as abolishing prescription charges, free dental care for 18 to 25 year olds and free eye tests.
The data available for comparison demonstrates clearly that the Scottish NHS has been performing more effectively than any other UK national health service:
- Based on data from 2021/22, Scotland currently has the highest healthcare spending per capita of the four nations that make up the UK at £3,781. England has the lowest per capita spending at £3,459.
- Scotland possesses 64 GPs (Whole Time Equivalent) per 100,000 people, compared to 48 in England and 50 in Wales.
- There are also 1,181 nurses and midwives (WTE) in Scotland, versus just 610 in England.
- Despite criticism over high waiting times in A&E, 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 better than only 56.8% being seen in under four hours in England. This is also despite Scotland and England measuring waiting times differently until recently, making the disparity even more stark.
- A&E units in hospitals under the NHS Tayside health board, in particular Ninewells Hospital in Dundee, are consistently some of the best performing in the UK and are used as a model by the Scottish Government in achieving wait time targets.
Remaining part of the UK, it is unclear how long the Scottish Government could maintain NHS Scotland's performance and funding. Tellingly the Chancellor, Jeremy Hunt has co-authored a book calling for NHS privatisation. Meanwhile, the UK’s 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. The threat doesn't just come from the Conservatives – a think tank run by former Labour Prime Minister Gordon Brown has called for the abolishment of free prescriptions in Scotland.
Having to operate in an environment in which funding has been starved from Westminster, the Scottish Government has nonetheless remained committed to ensuring the NHS receives better than average resources. In a new paper published by the Scottish Government, protection of the Scottish NHS is incorporated into a plan for an independent Scottish constitution.