Sunday, 14 September 2014

Our NHS. Why the Yes campaign must destroy a UK-wide service

With the polls coming together as the referendum approaches, it would seem a good time to analyse the importance to that debate of the controversial claims around our NHS

This is a difficult issue for the Yes campaign. Firstly the NHS is that rare thing, a UK-wide institution that is both respected by experts and valued and supported by people across the UK; obviously the complete antithesis of what Yes campaigners want to see. Secondly, it is funded as part of a system (Barnett) that makes at least some attempt to recognise differing demands of different parts of the UK and fund them accordingly. Again an example of an UK-wide positive process that would be killed stone dead by a Yes vote.

In short and in principle, the NHS is a good example of what Better Together should be trumpeting. Sharing UK resources so that anyone in any part of the UK can receive treatment free at the point of delivery, wherever they need to receive it. Why BT hasn’t done so enough, we'll deal with in a minute.

Are the threats real?
The Yes campaign have to deal with the inevitable break up of our NHS that their aims predicate. To invent a back story for this split, a) they have tried to create an image of an irreparably damaged NHS South of the border, and b) argue that the only way out is to pull up the ladder, and abandon the rUK NHS. To do so they risk the claim that they will cut the 'hassle free access to specialist clinical facilities in England, Wales and Northern Ireland' that doctors put so much importance on, and abandon the collective creation, involvement and resourcing of our UK NHS.

So, if a successful UK-wide institution delivering services to us all is so clearly a problem it has to be denigrated. And not just for failings in England, but if possible how those failings will eventually reach across the border.

Eleanor Bradford of the BBC
So the targets picked on by the Yes campaign were Barnett and how it is threatened by English privatisation, and - when it quickly became clear via Eleanor Bradford amongst others, that privatisation itself threatens Barnett in no way - the overall impact of lowering levels of service in England and the knock-on damage to Scotland's Health Service.

What did SNP MPs think?
However, Yes have another problem with the 'impact of NHS privatisation on Scotland' argument. As is well known, SNP MPs do not (as a matter of principle) vote on legislation that has no impact in Scotland. But obviously, the Health and Social Care Act 2012 (the main coalition legislation opening health care up to private commissioning) DOES impact, doesn't it? Everyone from Dr Philippa Whitford to Alex Salmond has
Dr Phillippa Whitford
told us so. However you'll look hard to find the SNP MPs voting against that bill (neither in the second nor the third reading!). Surely they couldn't have been under the impression its impact on Scotland would be non-existent (twice)? Hopefully, if a Labour government committed to repealing that law - as both Burnham and Miliband have committed to do - is returned in 2015, they won't make the same mistake again.

However, no matter what SNP MPs might think, the Yes campaign’s point about the privatisation of England's NHS does have an impact on Scotland and Scottish patients. Currently - although the NHS is run differently either side if the border - all UK patients are entitled to get the most appropriate care for their condition in the most appropriate venue. In some cases that means English specialist hospitals. That has been made clear by Sir Leonard Fenwick, the chief executive of the North East NHS foundation when he replied to Dr Whitford's bogus claims about cancer surgery in his area. A number of us also remember the emergency airlifts of Scottish patients suffering from swine flu, to a hospital in Leicester. The prospect of these areas of specialism down in England suffering because of the introduction of profit-driven, resource-undermining privatisation is very much something that we in Scotland should be concerned with. And we should be campaigning with our fellow NHS supporters across the UK to ensure that privatisation is stopped in its tracks and the Health and Social Care Act is repealed.

It is disappointing that Better Together seem to have been a) hypnotised by the 'Barnett myth' and b) hamstrung by the presence of parties representing the architects of this privatisation, and failed to highlight the REAL dangers to Scotland’s patients, but at least the Labour opposition at Westminster has made a clear commitment to repeal the odious Act.

Campaigning for the NHS across the UK
External support, or joint campaigning
We could still campaign in support of the English NHS in an Independent Scotland, of course, although we would a) then be offering solidarity to campaigners in a different country with a different healthcare system, and b) no longer have a right and a stake in a UK-wide NHS. Not impossible then, just unnecessarily more difficult.

And this leads to another objection that the Yes campaign has to challenge. The right of us all as patients to use the NHS across the UK would cease. Now, it is possible, even probable, that arrangements would be negotiated to allow continued access, but they would have to be created via some financial bargain, as Scottish and rUK populations would no longer be contributing to one cross border system.

Plus, of course, the real cast iron danger to any redistributive effect (however small) that exists in the Barnett formula doesn't come from English privatisation, or even from 'revenge plots' by Westminster politicians, but from a Yes vote! Separation of the nation, means separation of national healthcare systems, and separation of the tax and spend arrangements that fund them. So – no Barnett, no redistribution from a bigger pool to a smaller.

Our NHS, Our Campaign
So, while no one underestimates the danger to the NHS from privatisation, it is surely more likely to be defeated by working and campaigning together as part of our NHS, than by striking camp and stealing away into the night? An argument that can also, incidentally, be applied to many other pan-UK struggles and campaigns.

And ultimately this is why the break up of our NHS is quite so crucial to the Yes campaign. It is not just a successful practical service, it is also a symbol of a UK success with input from us all, and access for us all. Let's keep it that way. Vote No to continue and increase the campaign to defeat privatisation of our NHS - wherever that is threatened.

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