Saving the NHS from the SNP

The revelation that managers in the Scottish NHS were considering a two-tier health service raises difficult questions for the SNP, whether we are inside or outside the UK.

The aggressiveness of the reaction from nationalists to media scrutiny is in direct proportion to how damaging a story is to the SNP. On that basis, the furious response to the revelations that NHS managers discussed introducing charges for health treatment means that story must have been very damaging indeed.

Not for the first time, the BBC were forced to issue a statement defending their own reporters as SNP politicians joined the pile-on against them. I was proud to see my own party leader defending their right to publish what were documents which the public clearly had the right to know about. So why was the reaction so extreme?

The NHS is the UK’s religion

Belief in our egalitarian NHS is an almost religious principle for people in across the UK. The British Social Attitudes Survey shows overwhelming support for the founding principles of the NHS. 94% of us think our NHS should be free of charge when you need it, 86% think our NHS should primarily be funded through taxes, 84% think it should be available to everyone.

Such a solid consensus behind a socialist institution is deeply uncomfortable for a political movement that exists to convince that those people down there have incompatible social values to us up here. That is one of the reasons the SNP ran such a silly campaign to convince people that the NHS across the UK was about to be abolished. It wasn’t a policy argument about protecting the NHS. How could it be given the NHS was already devolved in Scotland? It was really an attempt to drive a wedge between Scotland and our friends in England.

We witnessed what we shared during the pandemic. The uncomfortable reality for the SNP was that homes across the UK were united as we taped to our windows homemade expressions of love for the NHS. Our applause for NHS workers echoed on both sides of the border they would draw between us. We all have loved ones who are only with us thanks to the miracles performed, without charge, every day by the NHS. Our shared faith in the NHS continues to connect us together, despite all their attempts to divide.

The threat to the NHS is SNP incompetence

Ten years on from claims that those villains down South were coming for our NHS, it is still here. But it has turned out that the bigger threat to the NHS wasn’t from a government in London but rather from the one in Edinburgh. As Neil Mackay writes in the Herald today, it is the SNP who are destroying the NHS:

“If the NHS is a benchmark, then the SNP is unfit for government. It’s becoming hard not to see the SNP as, in essence, an umbrella campaign group that simply wants independence, rather than a party dedicated to making the powers it has work as best they can.”

The Scotsman’s leader today gets to the real point of the story:

“Whether or not this was part of a brainstorming exercise, it is deeply concerning that it has come to this.”

Every day there is a fresh story about the SNP’s mismanagement. In the last few days we have seen reports:

• that GPs are texting patients to say they are only accepting emergencies;

• that there are more than 300 unfilled GP vacancies;

• that nurses are to strike over patient safety with 6,000 nursing vacancies unfilled;

• ambulance service workers also voted to take action over the lack of capacity that is leaving patients waiting hours for an ambulance;

• of the worst-ever waiting times for Accident and Emergency patients in history;

• and of the ongoing tragedy and scandal of drug deaths after cuts to treatment services.

In this context, a two-tier system is already being created. The number of Scots paying to go private for treatment that should be provided by the NHS is up by two-thirds.

Little wonder Jackie Baillie has been dogged in calling for the Health Secretary to resign. That breaks the rules of political tactics: you don’t call for someone to resign unless you are sure they will go. But Baillie knows that Humza Yousaf’s inability to get a grip of the multiple crises means this story will become what politicos call ‘a dripping roast’: that is a story that keeps going and going, slowly cooking your opponent’s political brand.

The reason Yousaf is probably safe in his job is that so many of the crises in our NHS began when Nicola Sturgeon was sat behind his desk. The staffing shortages throughout the health service have their roots in her failure to plan. She ran the NHS for years, before giving up that job to focus on a more important priority: running the independence campaign. Speaking of which…

The SNP’s pearl-clutching at the very thought that anyone could believe they would even consider replacing the NHS with a system of fees for treatment is undermined by their own campaign to leave the UK. Consider the SNP’s recent series of independence papers.

The SNP have refused to guarantee NHS spending outside the UK.

We know from GERS, the official public finance statistics, that for the last few years around £10 billion a year has been redistributed from the South East of the UK to Scotland. This is our share of UK funds, like most other parts of the UK, when you total up what we pay in taxes and compare it to what we spend on public services and welfare we are net beneficiaries. Unlike other parts of the UK, however, we have a government that wants us to vote to give up our share of these funds.

That £10bn a year that we would have lost had we been outside the UK is a significant figure: it is roughly equivalent to the budget of all NHS health boards in Scotland. The idea we could lose an equivalent amount to all of our NHS spending in hospitals, community settings and primary care, and then not see an impact on the NHS is stretching credibility.

Of course, the SNP could counter this argument by offering figures for what public spending in a separate Scottish state would look like. However, when they published their recent plan for the economics of independence they declined to offer any figures for public spending. This is odd given the White Paper on Independence published by Nicola Sturgeon in 2014 gave a commitment to maintaining NHS spending. When they renewed their case they gave no such commitment because they have given no commitments of any kind on spending.

If they do it, why couldn’t we?

The first of the new papers published by the First Minister identified ten countries as examples of the sort of economic dynamism and social solidarity that Scotland should aspire to. Throughout we were invited to ask the question: ‘if they do it, why couldn’t we?’ So let’s do that. Here’s what a chapter would look like on what we can expect from emulating their health systems.¹

• Ireland has no NHS. A means-tested medical card covers less than a third of the population with charges common for others using the health service. Visit A&E without a GP referral and you’re charged £86. Visiting a GP is between £35 and £52. Inpatient charges are £70 per day.

• In Denmark, unlike with the NHS, the state does not have a direct role in the delivery of healthcare, though hospitals are funded through income tax. 40% of Danes purchase additional health insurance.

• In Sweden, they have a universal health system but a fifth of public health provision is provided by private hospitals. There is a charge of between £10 and £30 to visit a doctor.

• Finland’s public health system charges fees to patients. Seeing a doctor costs around £17 to see a doctor. £23 is charged for an outpatient consultation and £28 per day for inpatients.

• Norway charges £30 to see a doctor or to be consulted in a hospital.

• Iceland has a public system but 1/6 of the funding comes from such charges.

• In Switzerland, patients are required to take out compulsory private health insurance. Premiums charged by these not-for-profits average £5,000 a year. Patients pay costs for seeing a doctor up to a certain amount agreed upon with their insurer. Most people choose a deductible of about £260.

• Austrians going to hospital pay a daily fee of between £8 and £17.

• In Belgium instead of an NHS there is compulsory health insurance and private providers deliver healthcare. They pay around £20 to see a doctor and £85 a week for an inpatient stay. They then submit this to insurers who will repay some of this.

• In the Netherlands, competing health insurers fund most of what the NHS does. Other social insurance and the central state cover long-term care and social care. Patients are charged fees up until the deductible of £333 (the amount where insurers start to pay the costs).

The countries whose social model the SNP say we would be modelled on do not have an NHS. Instead, they have private hospitals, competing systems of health insurance, fees for seeing GPS, charges for seeing a specialist, and daily payments for staying in hospital.

They cannot have it both ways: either these countries are the model for us or they are not. It speaks volumes that the countries they admire are those who do not share our commitment to healthcare for all, free at the point of use.

Those of us who want to protect the NHS from the economic damage of nationalism can confident make the argument that:

• The commitment to a free NHS is shared deeply by everyone in the UK, despite the SNP’s attempt to divide us from each other.

• That the SNP have declined to say how much would be spent on the NHS after leaving the UK and giving up our share of UK funding - equivalent to the budget of every NHS hospital.

• That none of the ten countries the SNP’s independence plan chose as examples of what Scotland would be like after leaving the UK have an NHS. Instead they have private insurance, private hospitals, charges to see your GP, visit A&E, or to stay overnight in hospital.

• The real threat to the NHS is the SNP’s incompetence: with record waiting times, ambulances that don’t turn up when you need them, staff shortages, and secret discussions about introducing charges or reducing services.

The NHS used to be viewed by the SNP as a source of political advantage. Today the campaign, lead by a man who argued that our health service should be privatised and replaced with private insurance, might find that it has become their biggest weakness.

Culture Corner: The Hands of Others

The text below by James Stockinger is often published as a poem. Remarkably though it was actually a passage from his PHS thesis. It was just so well written that it read like verse. It’s link to the philosophy behind the NHS should be obvious:

It is in the hands of other people

that supply the needs of our bodies,

both in our infancy and beyond.

For each of us lives in and through

an immense movement

of the hands of other people.

The hands of other people lift us from the womb.

The hands of other people grow the food we eat,

weave the clothes we wear and

build the shelters we inhabit.

the hands of other people give pleasure to our bodies

in moments of passion

and aid and comfort in times of affliction and distress.

It is in and through the hands of other people

that the commonwealth of nature is appropriated

and accommodated to the needs of pleasures

of our seperate, individual lives, and,

at the end,

it is the hands of other people that lower us into the earth.

By the way, if there is a piece of art, writing, music, or whatever that you think speaks of the values of solidarity and unity which you would like to suggest for this corner of the newsletter, get in touch!

1. The information above is taken from international organisations’ audits of the healthcare systems in these countries and some may have changed since they were published. Happy to amend if anything has become incorrect with the passage of time.