{"id":38973,"date":"2014-09-18T11:49:58","date_gmt":"2014-09-18T11:49:58","guid":{"rendered":"http:\/\/samathieson.com\/sa-mathieson\/?p=38973"},"modified":"2026-04-05T11:10:12","modified_gmt":"2026-04-05T10:10:12","slug":"nhs-scotland-independence-guardian-updates-beacon","status":"publish","type":"post","link":"https:\/\/samathieson.com\/sa-mathieson\/nhs-scotland-independence-guardian-updates-beacon\/","title":{"rendered":"How Scotland\u2019s NHS would be affected by a yes vote"},"content":{"rendered":"<p>Today and tomorrow, I will be <a href=\"https:\/\/www.beaconreader.com\/sa-mathieson\/the-end-of-britain-possibly-live\" target=\"_blank\" rel=\"noopener noreferrer\">writing updates on Scotland&#8217;s referendum on independence every few hours for Beacon<\/a>. To clarify, in the title &#8216;The end of Britain, possibly \u2013 LIVE!&#8217;, Britain refers to the country also known as the UK, not the islands we&#8217;re sitting on just off the north-west coast of Europe&#8230;<\/p>\n<blockquote class=\"twitter-tweet\"><p><a href=\"https:\/\/twitter.com\/samathieson\">@samathieson<\/a> <a href=\"https:\/\/twitter.com\/MrMalky\">@MrMalky<\/a> <a href=\"https:\/\/twitter.com\/BeaconReader\">@BeaconReader<\/a> Um I&#8217;m pretty sure that the land mass will remain unchanged.<\/p>\n<p>\u2014 Simone (@cee4cat) <a href=\"https:\/\/twitter.com\/cee4cat\/status\/512511957577261056\">September 18, 2014<\/a><\/p><\/blockquote>\n<blockquote class=\"twitter-tweet\"><p>\n<a href=\"https:\/\/twitter.com\/samathieson\">@samathieson<\/a> <a href=\"https:\/\/twitter.com\/MrMalky\">@MrMalky<\/a> <a href=\"https:\/\/twitter.com\/BeaconReader\">@BeaconReader<\/a> Maybe, but it did sound like the apocalypse was coming (don&#8217;t think No Thanks has mention that one yet) \u2014 Simone (@cee4cat) <a href=\"https:\/\/twitter.com\/cee4cat\/status\/512514658574802945\">September 18, 2014<\/a>\n<\/p><\/blockquote>\n<p>Whatever happens, the sun is going to rise over the islands tomorrow morning. Possibly behind some clouds, but that&#8217;s normal.<\/p>\n<p>Below is my piece for Guardian Healthcare Professionals, published on Tuesday, looking at how NHS Scotland may fare under independence.<!--more--><\/p>\n<hr \/>\n<p><!-- GUARDIAN WATERMARK --><\/p>\n<p><a href=\"https:\/\/www.theguardian.com\/healthcare-network\/2014\/sep\/16\/nhs-scotland-independence-yes-vote-policy\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"http:\/\/image.guardian.co.uk\/sys-images\/Guardian\/Pix\/pictures\/2010\/03\/01\/poweredbyguardian.png\" alt=\"Powered by Guardian.co.uk\" width=\"140\" height=\"45\" \/>This article titled &#8220;How Scotland\u2019s NHS would be affected by a yes vote&#8221; was written by SA Mathieson, for theguardian.com on Tuesday 16th September 2014 08.36 UTC<\/a><\/p>\n<p>The future of the Scotland\u2019s NHS has become a major issue in the independence debate, with both sides arguing that only they can save the nation\u2019s health services.<\/p>\n<p>This is despite Scotland already having operational control of its health services, as a result of 1999\u2019s devolution settlement. The Scottish government used this control to reorganise its NHS in 2004, into 14 health boards which provide all healthcare in their areas, removing the split between organisations commissioning and providing services which is used in England.<\/p>\n<p>Scotland has also removed patients\u2019 choice over which provider to use for some procedures, introduced public health measures such as a 50p-a-unit minimum price for alcohol (although this has been delayed by a legal challenge from the Scotch Whisky Association), and replaced private finance initiative funding with a non-profit equivalent.<\/p>\n<p>So it is not surprising that the <a href=\"http:\/\/www.scotland.gov.uk\/Publications\/2013\/11\/9348\/downloads\">Scottish government\u2019s white paper for independence, Scotland\u2019s Future<\/a>, does not include changes to the NHS\u2019s structure. However, the second televised debate between the yes and no campaign leaders heard first minister Alex Salmond saying that English moves towards \u201cprivatising and charging\u201d for healthcare could hit services in Scotland. Alistair Darling accused him of scaremongering, saying that the only person who could privatise the Scottish NHS was Alex Salmond. Former prime minister <a href=\"http:\/\/news.stv.tv\/scotland-decides\/291457-gordon-brown-vows-to-nail-the-snp-lie-on-nhs-privatisation\/\">Gordon Brown has said he will re-enter frontline politics to \u201cnail the SNP lie\u201d<\/a> about NHS privatisation.<\/p>\n<h2>Funding of the Scottish NHS <\/h2>\n<p>In reality, the arguments of both sides rest mostly on money. \u201cDevolution only protects Scotland from the policy decisions of Westminster, it cannot protect us from their cuts to Scotland\u2019s budget as a consequence of austerity and the erosion of public spending through privatisation and patient charging,\u201d says the Scottish government. \u201cWith independence we have the opportunity to protect the gains of devolution and protect public spending on the NHS and other key public services.\u201d It added that every \u00a310 cut from English health spending would reduce Scotland\u2019s by \u00a31 through the Barnett formula used to calculate transfers from Westminster to the Scottish government.<\/p>\n<p>The no campaign has responded that the Scottish government is already underspending on health. \u201cThe Institute for Fiscal Studies (IFS) showed this week again that the Scottish National Party (SNP) has withheld from the Scottish NHS rises in spending which even the Conservative party spent on the English National Health Service,\u201d <a href=\"http:\/\/www.theguardian.com\/politics\/2014\/sep\/14\/scotland-referendum-accusations-bias-campaign-trail\">John Reid, the former Westminster health secretary now sitting in the House of Lords, told a Better Together event<\/a> last Sunday.<\/p>\n<p>The IFS calculates that both the last Labour government and the current coalition one have increased healthcare spending faster than the Scottish government. From 2002-3 to 2009-10, real terms English NHS spending rose by 43% compared with 29% in Scotland. From 2009-10 to 2015-16 Westminster plans to increase English NHS budgets by 4.4% \u2013 despite a 13% overall cut in departments which serve England \u2013 compared with a 1% fall in Scotland.<\/p>\n<p>Some of this is down to Scotland shifting money into social care; uniquely among the UK\u2019s current nations, it provides free personal and nursing care for those aged 65 and over. But the <a href=\"http:\/\/www.ifs.org.uk\/publications\/7366\">IFS also claims that Scotland would struggle to support healthcare spending if independent<\/a>: \u201cUnder a wide range of scenarios, a combination of the eventual fall in oil revenues and an ageing population could make for a tougher fiscal outlook for Scotland than the rest of the UK and hence less room for additional spending on things like the NHS.\u201d<\/p>\n<p>Given the expectation that an independent Scotland would take the vast majority of tax revenue from North Sea oil and gas, it might seem that any such revenue will be a bonus. However, it currently receives much of it back under the Barnett formula, allowing the Scottish public sector to spend \u00a31,267 more per person in 2012-13 than the UK average, according to <a href=\"http:\/\/icas.org.uk\/News\/Latest-News\/-Scotland-s-tax-future--paper-published\/\">a report by the Insitute of Chartered Accountants of Scotland (Icas)<\/a>. Icas calculated that, based on an independent Scotland receiving the geographic share (the vast majority) of North Sea tax revenues, it would have had a public spending deficit \u00a3239 lower than the whole of the UK in 2011-12 \u2013 but that this would have reversed to one \u00a3470 higher in 2012-13.<\/p>\n<p>Scotland\u2019s higher public spending includes \u00a3203 more per person on its NHS than England, according to the Nuffield Trust. In a recent report, the healthcare think-tank said that in 2012-13 Scotland spent \u00a32,115 a year per person on healthcare, compared with \u00a31,912 in England. This is partly justified by poorer health; Scotsmen die on average when 76.6 years old, 2.3 years younger than the UK average; the figure for Glaswegian men is the lowest of any UK council area at 72.6 years. The expense of serving people in Scotland\u2019s lightly-populated areas is also a factor. But the extra money also provides Scots with free prescriptions, in common with Wales and Northern Ireland.<\/p>\n<p>The Scottish government argues that wider changes would make a difference. In Scotland\u2019s Future, it said: \u201cThe solution to ill-health is not in the hands of the NHS alone \u2013 it depends on breaking the cycle of poverty, educational under-attainment, worklessness, poor mental wellbeing, and, through these, preventable ill-health.\u201d Benefits are not currently devolved, and would be reformed: \u201cIndependence will also allow us to design a fairer welfare system.\u201d Control of welfare policies may also happen in the event of a no vote given recent pledges by the unionist parties, although details are not yet clear.<\/p>\n<h2>Changes to policy, research and pay <\/h2>\n<p>Sir Harry Burns, Scotland\u2019s former chief medical officer, has also <a href=\"http:\/\/www.snp.org\/media-centre\/news\/2014\/jul\/sir-harry-burns-yes-could-be-positive-health\">suggested that independence itself could mean Scots feeling more in control of their lives<\/a>, which \u201cwould be very positive for their health\u201d.<\/p>\n<p>Those campaigning for Scotland to stay in the UK have raised particular concerns over medical research. The British Medical Association\u2019s Scottish branch (which is formally neutral, but published a list of questions over independence) has pointed out that Scottish institutions currently receive nearly 15% of UK research council funding, compared with Scotland\u2019s 8.4% of the UK population. The Scottish government responds that \u201cwe will seek to agree maintenance of a common research area with the UK with shared research councils\u201d.<\/p>\n<p>Scotland has already taken a different view on NHS pay from the rest of the UK. Unlike England, it implemented UK-wide recommendations by pay review bodies, which it says means that Agenda for Change staff are \u00a3200 to \u00a3700 better off, with consultants \u00a3750 to \u00a31,000 richer. However, it has frozen distinction awards for such consultants since 2010-11, a move criticised by the BMA. However, this is already a devolved matter.<\/p>\n<h2>Waiting times <\/h2>\n<p>Andy McKeon, a senior policy fellow at the Nuffield Trust, says Scotland\u2019s NHS has followed England\u2019s in successfully cutting waiting times through strong enforcement of targets. The two nations did so in different ways: England increased capacity for conditions with long waiting lists through independent sector treatment centres, while Scotland bought a private hospital in Glasgow and turned it into the Golden Jubilee National Hospital, run by NHS National Waiting Times Centre Board to cut waits for selected procedures.<\/p>\n<p>McKeon adds that under devolution, Scotland\u2019s NHS has had other successes, in improving quality and in successfully introducing electronic health records, although England is starting to catch up on the latter. \u201cThey have an advantage over England in having a smaller nation, where you can get all the key people together act with cohesion,\u201d he says. But again, this will continue to apply regardless of the referendum\u2019s outcome.<\/p>\n<p>The main changes to the Scottish NHS as a result of Thursday\u2019s vote look set to be financial ones, and at least one group of health workers in Scotland appears to base its views on this. A survey published in August by the <a href=\"http:\/\/careers.bmj.com\/careers\/advice\/view-article.html?id=20018822\">British Medical Journal of 311 doctors working in Scotland found that 60%<\/a> planned to vote against independence compared with 33% in favour, and the biggest concern of those against was that Scotland\u2019s overall economy would suffer under independence, hitting the tax revenues used to fund its NHS.<\/p>\n<p><strong>Are you a member of our online community? <\/strong><a href=\"https:\/\/register.theguardian.com\/healthcare-professionals\/\"><strong>Join the Healthcare Professionals Network<\/strong><\/a><strong> to receive regular emails and exclusive offers.<\/strong><\/p>\n<p>guardian.co.uk &#169; Guardian News &amp; Media Limited 2010<\/p>\n<p>Published via the <a href=\"http:\/\/www.guardian.co.uk\/open-platform\/news-feed-wordpress-plugin\" target=\"_blank\" title=\"Guardian plugin page\">Guardian News Feed<\/a> <a href=\"http:\/\/wordpress.org\/extend\/plugins\/the-guardian-news-feed\/\" target=\"_blank\" title=\"Wordress plugin page\">plugin<\/a> for WordPress.<\/p>\n<p><!-- END GUARDIAN WATERMARK --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Scotland has controlled its own health services since devolution in 1999, but independence could affect policy and funding<\/p>\n<p>\u2022 <a href=\"http:\/\/www.theguardian.com\/social-care-network\/2014\/sep\/17\/scottish-independence-referendum-social-care\">How would social care be different in an independent Scotland?<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"categories":[2,6,7,13,14,304,19],"tags":[],"class_list":["post-38973","post","type-post","status-publish","format-standard","hentry","category-articles","category-healthcare","category-hospitals","category-nhs-finance","category-nhs-jobs","category-politics","category-scotland"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>NHS Scotland independence for Guardian, updates on Beacon<\/title>\n<meta name=\"description\" content=\"Article from Tuesday for the Guardian on NHS Scotland independence, and live updates today and tomorrow on Beacon\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link 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