Free cradle to grave healthcare in NHS Scotland or the Great British NHS Sell-Off?

A guest post by Dr Nancy Burge

Did you know that in England the Health and Social Care Act of 2012 made the most fundamental change to the English NHS in since its inception by removing the UK government’s obligation to provide universal healthcare?

Did you know that in England the biggest contract ever tendered in the history of the NHS in England is a £1.2 billion pound deal to sell off cancer services and care for the dying?

And did you know that over 200 Westminster MPs and members of the House of Lords have financial interests in health care companies in England?

The privatisation of the NHS in England is now rapidly increasing.  With the Health and Social Care Act of 2012, for the first time since 1947 the Secretary of State not only abdicated his responsibility to provide healthcare for all in England but has got the legal powers to introduce a market, allowing providers to pick and choose which patients will get care and what will be charged for and also to introduce insurance structures similar to those in the USA.

Michael Portillo confirmed in a TV interview that these plans were deliberately kept out of the Conservative manifesto because of the risk of losing votes.  And it’s not just the Conservatives who are in on this plan.  Andy Burnham, Labour’s Shadow Health Secretary, signed off the privatisation of Hinchingbrooke Hospital during Labour’s final year in power and told Holyrood magazine, “Let’s get health policies that can be consistent across England, Scotland and Wales”. But with an impending election he has changed his mind and calls for a pause in privatisation.  In his latest speech Andy Burnham now says “If things stay as they are, the competition framework foisted on the NHS will in the end break it up. It won’t survive five more years of this.”

In England entire NHS hospitals are being turned over to private companies.  Healthcare services are now being split up into smaller chunks.  An explosion of new private providers are waiting to cherry-pick the most profitable services ranging from mental health services, GP and Out Of Hours services, to diagnostics such as blood tests, x-rays and scans.  Ambulance services are now being run by bus companies.  No one really knows yet how the financially less attractive services will be run in the future.  And how can we be sure that any of these services are being run for the good of patients rather than the profit of the shareholders?

Do you remember the catchphrase of the NHS that it provides “care from cradle to grave”?  Well, the whole range of services from maternity services to care of the dying is all going out to tender in the Great British NHS Sell-Off.  The largest contract in the history of the NHS is a £1.2 billion deal for providing cancer services and care for the dying.  So some of the sickest patients in England will have their treatment dependent on a provider whose bottom line will be profit.

Why this isn’t in the newspapers. How can this be happening right under the noses of people in England?

It is because these private healthcare providers are allowed to hide their true colours under the existing badges and logos of the NHS.  All you will see in these privately-run clinics where doctors and nurses wearing NHS identity cards on NHS lanyards treat their patients, are the usual NHS signs.  Sir Richard Branson’s Virgin Care says “as we are providing NHS services, NHS brand guidelines require us to ensure that the NHS is the primary logo”.

Companies such as Virgin, Serco, Harmoni, Care UK, and Ramsay Health are hoovering up the healthcare contracts.  Yet this massive privatisation process is going on totally under the radar because of the branding rules.  And because of EU anti-competition laws it will be difficult to reverse.

But what has all this got to do with the NHS in Scotland?  If the NHS in Scotland has been functionally independent since 1999, surely we are ok?

Without devolution NHS Scotland would have been repeatedly reorganised by the Westminster Government of the day, regardless of the special needs of Scotland.  And since 1999, we have had free prescriptions, and free personal care for the elderly since 2002. Scotland was the first country in the UK to introduce the smoking ban.  We have a separate contract for GP services in Scotland.  We have Health and Social care now working together to provide a better service and save money. NHS Scotland has always a separate pension scheme.  There is also a separate pay structure which meant that Scottish NHS health care workers got the recommended 1% pay rise denied to those in the English NHS.  And the loophole which would have allowed private providers into Scotland was finally blocked by Nicola Sturgeon in 2011.

So won’t all this good stuff just carry on, regardless of what we vote on 18th September?  Why do we need to vote YES to save the NHS?

A No Vote will allow Westminster to control the overall level of Scotland’s budget and continue to make decisions that directly affect poverty and health in Scotland through the tax and benefits system.

Westminster can still force changes on the Scottish NHS because of its tight hold on the purse strings.  The status quo is really is no longer an option where the NHS in Scotland is concerned.

Currently, Westminster gives Scotland a fixed percentage of the public expenditure of UK as a whole, known as the Scottish Block Grant.  The Scottish Government chooses to spend about 40% of the Scottish Block Grant on running NHS Scotland.  Up to now the Barnett formula has guaranteed Scotland a fixed percentage of the total of public expenditure in the UK.  As public expenditure fluctuates in in the UK our proportion is fixed.  When it goes up, we get more –but when it goes down, we get less.  The Barnett formula has now only been guaranteed for one more year.  After that Westminster will decide how the money is to be divided up based on their assessment of the needs of the four nations.  I believe that is a fair assumption that our proportion will be smaller.

But how does this affect Scotland?  I thought that devolution meant the Scottish NHS was safe?

The privatisation of the NHS in England threatens NHS Scotland not only because of its knock-on effect on our funding but also because it exposes us to the proposed Transatlantic Trade and Investment Partnership agreement.

As private sources begin to replace public expenditure on the NHS in England, we can see that the amount of public money being spent on health will decrease. And so, as the total UK public expenditure goes down, the consequence to Scotland will inevitably be a decrease in our funding. There will be an even smaller funding cake for the four nations to share. And with the planned loss of the Barnett formula in a year, Scotland is likely get an even smaller slice of this even smaller cake.

But privatisation of the NHS in England puts Scotland’s NHS at risk in another way.  The Transatlantic Trade and Investment Partnership or TTIP is an additional threat to Scotland’s NHS.  This trade agreement between the European Union and the USA requires that state services to be open to competition from American multinationals.  It applies where privatisation is already established, unless there is an existing state monopoly.  When the UK Health and Social Care Act introduced a private market in health provision in England, it opened whole of the UK to TTIP.  After a No vote, private providers and insurance companies could argue that Scotland is only a region of the UK and cannot be exempted from competition for health provision.

So only by becoming an independent state can Scotland can protect the Scottish NHS.

Let’s just look closely again at the two very different paths taken by the NHS in England and in Scotland over the last few years.

There is now a market economy in healthcare in England, using private providers whose bottom line is profit.

In Scotland, since devolution the Scottish government has worked to keep NHS Scotland true to the founding principles of the NHS, by continuing to provide and improve its unified, publicly funded service, free for all at the point of use.

A few days ago, First Minister Alex Salmond proposed that an Independent Scotland should “guarantee that not only will the NHS be kept in public hands, but that the services that are free to access today will be free to access in the future.”

A vote for YES really will give us the chance to protect our beloved NHS in the new nation of Scotland for generations to come.

On the 18th of September this NHS doctor will be voting YES – I really do hope you will too.

Nancy Burge is a GP in the Isle of Skye

60 comments on “Free cradle to grave healthcare in NHS Scotland or the Great British NHS Sell-Off?

  1. […] Free cradle to grave healthcare in NHS Scotland or the Great British NHS Sell-Off?. […]

  2. […] A guest post by Dr Nancy Burge Did you know that in England the Health and Social Care Act of 2012 made the most fundamental change to the English NHS in since its inception by removing the UK gove…  […]

  3. JimnArlene says:

    Frightening stuff, sod the money men, vote yes.

  4. handclapping says:

    Good piece. I worry about any guarantee that the NHS will remain the same whatever, forever. The NHS was and still is one part of a whole scheme of social security that was appropriate for the conditions of the 1940s and the experiences of the 1930s.

    The Westminster government are on a process of altering the parts of that social security compact with the populace without advisement from them. They can control the interactions of their chosen benefits and care commitments with their support of the English NHS. However they get to choose the benefits and care applicable in Scotland without any consideration of their effect on the way Scots live or our NHS

    What I hope will happen is that in an iScotland we will have that engagement, like wartime Britons had with the Beveridge Report, with our Parliament to produce a scheme of social security fit for the 2020s and alterations to the NHS may be part of coming up with that better overall social security scheme.

  5. […] Free cradle to grave healthcare in NHS Scotland or the Great British NHS Sell-Off? […]

  6. Steve Asaneilean says:

    Brilliant Nancy.

    And in case anyone is in any doubt about the Barnett formula, the stated aim of Westminster is to reduce public spending so even if Barnett is retained its value to Scotland must fall if Westminster achieves its sated aims on public spending.

    But, despite noises from BT?NT to the contrary, as you point out Nancy there is real doubt that Barnett will survive and its replacement will certainly not be more favourable to Scotland than Barnett. And there are plenty indications out there that all the Westminster parties want to see Barnett chopped as these quotes posted on Wings Over Scotland in February clearly demonstrate (the “best” one being from Joel Barnett himself after whom the formula is named):

    David Cameron, Prime Minister – “[The Barnett formula] cannot last forever, the time is approaching”

    Alistair Carmichael (Liberal Democrat) – “We do want to see Barnett scrapped. We want to see that replaced by what we call a needs based formula.”

    Margaret Curran (Labour), Shadow Scottish Secretary – “I do believe that we should allocate public funding on the basis of need and it should not be around just a regional or a national demarcation around that.”

    The House of Commons Justice Select Committee – “The Barnett Formula is overdue for reform and lacks any basis in equity or logic. It creates controversy in all of the constituent parts of the UK. There is controversy in England that the Barnett Formula allows for higher levels of public spending in Scotland from the UK Exchequer and does not deal with different needs in different parts of England. We urge the Government to publish its position as a matter of some urgency and to proceed to devise a new formula which is needs based, takes into account regional disparities in England as well as in Scotland and Wales, is transparent and is sufficiently robust to enable long-term planning.”

    Local Government Association, England – “Council leaders in England are to campaign for Scotland’s block grant to be cut. Local government chiefs south of the Border say they are envious of the powers and funding given to a devolved Scotland and have revealed they will push for the UK Treasury to scrap the Barnett formula, the system that gives Scotland more per head of UK funds than it does to England and Wales.

    The All Party Parliamentary Taxation Group – “The APPTG echoes the findings of the House of Lords Committee on the Barnett Formula in recommending that a shift is required towards a ‘needs-based’ formula, whereby a ‘dynamic’ and ‘simple, clear, and comprehensible’ system is used to allocate resources to the devolved regions ‘based on an explicit assessment of their relative needs’, calculated ‘per head of population’.”

    Ruth Davidson, Leader of the Scottish Conservative and Unionist Party – “Barnett was only supposed to be temporary… I do think that there will be a review of Barnett after 2014. The ground has shifted since devolution.”

    Lord Lang of Monkton – “On the Barnett surplus, everyone knows that the basis of the present distribution of funds is out of date. We know that that, too, created an imbalance that can be put right. A fair-minded Scotland would agree. We need an up-to-date measurement of relative need in Scotland and elsewhere in the United Kingdom.”

    The Calman Commission – “The commission has decided major changes need to be made. Significantly, however, experts believe the change will result in a drop in Scotland’s budget – which could lead to cuts in service”.

    Lord Joel Barnett, who devised the formula – “It’s quite wrong. It clearly should not be based on per head expenditure but should be based on needs in particular areas. The amount of money going to Scotland on a needs basis by comparison, say with my own North West or the North East, is far higher than it should be, so it should be changed. They’d lose quite a bit in my guess, done on a proper needs basis”.

  7. JGedd says:

    Yes I knew about the looming danger of TTIP which is why I signed a petition recently to protest about its ramifications. Disgusting as ever are those Labour politicians who rush to tell people that those who say that the NHS in Scotland is endangered with a No vote are scare-mongering. Dr. Burge’s excellent and timely post details the awful prospects for our NHS if there is a No vote. I hope to disseminate this as far as possible. Thank you

    ( While we are talking about the trimmers and finaglers in Scottish Labour, I hope that those who always awarded the benefit of the doubt to Malcolm Chisholm will have been disappointed in his recent performances in the Scottish Parliament in which Mr Chisholm seems to be clearly behind the Union message. It is not a respectable position to take any more for the Labour party and Mr Chisholm appears to be just as vehement in his defence of the Union as Neil Findlay, for instance, recently heard denying that the NHS in England was being privatized. Mr. Chisholm hoping to retire to the Lords? )

  8. Hugh Wallace says:

    Reblogged this on Are We Really Better Together? and commented:
    “Did you know that in England the Health and Social Care Act of 2012 made the most fundamental change to the English NHS in since its inception by removing the UK government’s obligation to provide universal healthcare?

    Did you know that in England the biggest contract ever tendered in the history of the NHS in England is a £1.2 billion pound deal to sell off cancer services and care for the dying?

    And did you know that over 200 Westminster MPs and members of the House of Lords have financial interests in health care companies in England?”

  9. Capella says:

    You certainly have my vote Nancy. We have to protect our Health Service from the corporate vultures circling the UK . Great post.

  10. Steve Asaneilean says:

    And do remember that the NHS was not the invention of Aneurin Bevan and the Labour Party – it was based largely on the Highlands and Islands Medical Scheme which was set up by the Liberal government of 1913 following the recommendations of the Dewar Committee of 1912. That Committee based its advice largely on the recommendations of a single radical GP from Ballachulish called Lachlan Grant. Famously Grant stood up for the workers in the Ballachulish slate quarry and was sacked for his trouble. The workers then went on strike for a year until he was reinstated. There should beva statue of Grant outside the HQ of NHS Scotland – there should be but there isn’t.
    For more information on Dewar and HIMS please Google

  11. David Agnew says:

    I did say I was withdrawing from posting – I increasingly feel that I was speaking from an echo chamber at times. but this one does merit a comment.

    Lalland peat worrier did a brilliant piece on the danger of triangulation

    the book he mentions is also worthy of a mention.

    The Tories are now in the process of dismantling the NHS. But it was labour that started the process. Even now they are talking about a UK nhs – for one simple reason. No not the idea that a single institution would make sense, only that it would be easier when it came to selling it all off.
    When Burnham called for a halt, he wasn’t worried about what they were doing, he was worried that would only happen in England and not in Scotland too.

    The Tories don’t really care if we have a publicly funded healthcare system – they control the purse strings after all. But they also simply don’t care how it would play in England. With the English having to get medical insurance, how are they going to feel if they see Scotland with its own public NHS. There will be a lot of anger, and in my opinion one of the reasons that will condemn the Union to ruin even if there is a NO vote.

    Labour know that the minute Scotland takes on look at the insanity happening south of the border, they simply will not trust UK labour with the NHS, let alone the Tories. Like Holyrood, our NHS will be a thumb in the eye for the likes of Lamont, Sarwar, Curran and all the other miserablists that think we’re better together. It would concrete proof that we aren’t and frankly probably haven’t been for quite a well….better together that is. No one is going to trust Davidson or Rennie further than they can spit and no voters are going to look like the dumbest fuckers in the room.

    Yes or no – the union is finished.

    How wrong to have been so negative, how wrong to have been so gloomy, how wrong to have run away from life, how wrong to have said no, again and again, instead of yes – dear god in heaven let it be yes.

  12. macart763 says:

    An NHS protected in a written constitution.

    Think about it.

    • handclapping says:

      See my comment above; if it is written into the constitution we may be unable to change it eg USA right to bear arms. In addition to how our NHS fits into social security provision, how are we going to deal with “self-inflicted” ill-health like bariatrics, or the “illnesses” of extreme old age?

      • macart763 says:

        Its dependent on just how you word the protection, just like all legal documents. Also constitutions can be amended by popular mandate.

      • bjsalba says:

        Most people don’t want to have a high sugar, high fat diet but the supermarkets have been loading up all our food bit by bit over the years.

        They need to take some of the blame and participate in the solution.

  13. Yet daily we hear and read of unionists (including Jackie Bird in her supposed interview with the First Minister) insisting that to say the NHS down south is being privatised is a lie. They scream of scaremongering — well maybe it does scare some folk to open their eyes to what is happening, and what the likely outcome will be in Scotland if there is a No vote. People have a right to know, need to pull their heads from the sand and realise what’s in store if they continue to shut eyes and ears and plod blindly towards the No box.

    This article needs to be spread far and wide to help inform people. If the NHS is an important issue to women, then the facts need to be freely and widely available.

  14. Tris says:

    Brilliant piece. Much appreciated information form someone who clearly knows.

    Also obliged to Steve Asaneilean for his piece on Barnett. I hope you won;t mind Steve if I use that with credit to you, on my blog.

  15. MBC says:

    There were parts I didn’t understand in this otherwise excellent article. Can anybody illuminate?

    How exactly is the NHS in England being privatised? How are budgets being slashed?

    Do I take it that the government is giving contracts to private companies to provide care and treatments, rather than using in house NHS units?

    In that case, isn’t the government still paying the bill?

    Is the government thinking that these companies will do the job cheaper? (A big ‘if’, IMHO).

    What is this talk of English people needing insurance? Isn’t that what National Insurance is?

    Sorry but just want clarification.

    • Steve Asaneilean says:

      Hi MBC – National Insurance doesn’t cover the cost of health and welfare (if it ever did).
      Privatisation is occurring in the form of private companies being given contracts to run NHS services. The biggest expense in the NHS is staff costs. The UK Government wants to introduce variable terms and conditions across the NHS in England as well as generally reducing costs and it can do both by putting services out to tender.
      But just to put things in perspective – like Nancy I am an island GP. Together with my partners in our practice we look after 5500 people as well as three nursing/residential homes and a busy community hospital which hss 400 admissions and 3000 A&E attendances a year. We have 8 doctors and 4 nurses and run in-house clinics for asthma, hypertension, diabetes, etc. and we offer 15 minute appointments.
      The total cost of all this to the NHS is £180 per person per annum. Show me a private provider who can provide that level and quality of service for that and I will eat my stethoscope 🙂

      • MBC says:

        …So, just to be really clear, the government is still paying for these services, they are still free to patients, it just puts them out to private tender, and hopes that this will save them money? The issues being, what happens to the NHS staff currently providing these services; (presumably made redundant); how come a private company can offer cheaper;(presumably by cutting corners on quality and staff benefits, thus demoralising the staff providing the care); what happens if there are any concerns about quality of care such as wrong lab results on tests – can the company be sued? Or do their lawyers have it all stitched up?; and finally, as you point out (and Malcolm Chisholm said the same the other day) is it really cheaper at the end of the day?

  16. rowantree633 says:

    Reblogged this on A Yes Voter in Nairn and commented:
    One of the risks of remaining in the Union and one that Jim Murphy MP refused to talk about when visiting Nairn a few weeks’ ago is the uncertain future of the Scottish NHS. This article sums things up very nicely. If you value the NHS in Scotland as a co-operative service from cradle to grave, don’t even consider voting to keep the Union…

  17. Dougie says:

    This is the party political broadcast by Labour warning that Westminster will starve Scottish NHS and education of funds whats changed in four years only there pay masters

  18. Pam McMahon says:

    I worked for the NHS when fundholding for GPs was introduced in the 1990s. It cost the taxpayer £millions and was spent on “Fundholding Managers”, new IT systems and previously unnecessary support staff.which allowed one GP practise I knew of to buy a new boat. This was within the East Sussex Primary Health Care system.
    So, it has all happened before, within the NHS, and NHS Scotland should be very cognisant of the effects of Tory/Red Tory privatisation.
    I hope the First Minister uses these arguments,and the new oil information more effectively and more passionately in his debate next Monday than he did the last time.

  19. nancyburge says:

    This post is mentioned above, and I have just read it and it is a brilliant clear explanation of how the private sector will make money out of the NHS and how the government aims to spend less.

  20. yerkitbreeks says:

    Agreed, as a Clinical Director I dealt with the lead GPs for Fundholding Practices and it was a shambles since they may have been good at treating patients ( a bit like us in the hospitals ) but hadn’t a clue on contracting. As they got better the change to a labour Govt phased them out !

    I need reassurance from Nancy, though, concerning the rebuke from BT on this issue. If the DoH dishes out money to in – house NHS providers, or to private ones, can it not maintain it is still spent on the English NHS, simply by another mechanism ?

    • Steve Asaneilean says:

      The stated aims of UK Government are to 1. cut public spending (so Scotland will get less) when we should be doing the opposite in my view; 2. cut taxes (so there will be less to spend on public services); 3. delete or reform the Barnett formula (so that Scotland will get less as the quotes above clearly imply).
      Scotland contributes about £50 billion to the London Exchequer but only gets £30 billion back.
      The UK Government is not handing NHS services over to Virgin Health in order to spend more surely…

      • yerkitbreeks says:

        No one can argue with all of that. I still need an authoritative answer to the specific question though.

        • Steve Asaneilean says:

          Okay – fair point. I hhave just emailed the UK Government for clarification on what counts as public spending and what does not and I will let you know tje outcome 🙂

        • Steve Asaneilean says:

          UK Gov says up to 18 days to reply – watch this space…

          • Doug D says:

            I think it’s Barnett consequentials that are the issue. If I remember correctly, NHS spending in England by the UK government has a block grant consequence for Scotland, whereas spending on privatised services doesn’t have a Barnett consequential. I’ll look out a link later if I can.

  21. bjsalba says:

    Does the money which is paid to these companies count as “public expenditure” which is what counts for Barnett or is it labelled “Government Expenditure” which would not count?

    If it is, then no doubt it was designed by the big four beancounters to favour their multinational clients and not the people of the UK, that is for sure. Same wheeze as continental shelf for oil and national projects for HS2 and the like.

  22. Skip_NC says:

    Greetings from Raleigh, North Carolina. As I read the Burdzeyeview link, I recognized healthcare in today’s USA. My wife is a Registered Nurse at a large teaching hospital, owned by the State of North Carolina. It is the Hospital of Last Resort – it takes the cases that private hospitals (for-profit and not-for-profit) either can’t or won’t handle. Sometimes, they have to send sick people home because there is a more needy case in the Emergency Room. Those sick people, of course, end up coming back into the hospital, because they were not ready to go home in the first place.

    It’s not a great thing for the patient and it’s not great for society as a whole. You see, this careful management of scarce resources results in federal government penalties for the patient coming back into hospital too soon. That means less money to spend on healthcare. It means less money to provide charity care for cancer patients at the end of their life. It means fewer qualified staff working in Home Health Services, who visit discharged patients to attend to their needs in their home. My wife comes home at the end of the week and basically crashes until Monday morning. Nobody benefits – not the patient, not society at large and not those who must care for very sick people. Why on earth would any sane person choose this system in place of what Scotland has now?

    • Steve Asaneilean says:

      Thanks for posting this Skip. Those of us who work in the Scottish NHS and who, like me, hhave spent some time looking at the US system fear exactly the sort of arrangements you describe. In this respect your post shines a light on what could happen if we don’t gain full control of our taxes and finances

  23. nancyburge says:

    Yerkitbreeks, I am not sure what point you want clarification on. Could you please state exactly what question you want answered?

    • yerkitbreeks says:

      Scotland and Wales / NI will get a percentage of what England spends on its NHS. My question is whether this spend can all be deemed NHS, irrespective of whether it goes via an NHS or private contractor ?

      • Nancy Burge says:

        We hope to get total clarification on this from the UK government.

        But however the expenditure is labelled, it seems to me that the same process will happen as when they tendered out council services like road maintenance.

        A newly formed consortium (on paper only, with no plant or staff unless it wins the contract), tenders more cheaply than the existing service, so existing expenditure goes down in the short term. The new winning consortium buys in all the old plant from the existing service at a knock down price, and they take on the old staff on temporary contracts, and run the service cheaply until the contract expires in three or five years or what ever. By that time the plant is knackered, possibly by natural wear and tear but probably also exacerbated by the bare minimum of maintenance. Then the contract for the service goes out to tender again, but this time round everyone retenders at a massively increased rate because they have got to buy new plant… so the service is now much more expensive and the only way the purchaser can now afford it is to buy-in a lesser service. Or at worst, decide not to provide it (postcode lottery for health care services, here we come).

        Imagine this happening with a renal unit with the dialyisis machines that were bought by the NHS. The expertise of the staff running the unit was provided by the NHS and that investment in training is going to be lost.

        And also all the data on safety and any new learning points will be lost in the future by this fragmentation of services- see Dr Philippa Whitford’s YouTube video and articles for more information on this.

        I predict a massive exodus of doctors from England in the future. I would not want to work in such a service.

  24. Anton says:

    But TTIP is not a Westminster initiative. It comes from the EU, which an independent Scotland is committed to joining. So independence would have no impact one way or the other as far as Scotland is concerned.

    • Steve Asaneilean says:

      TTIP is a bit up in the air at the moment but please read Nancy’s post again because you seem to have missed the point. The worry is that TTIP will let US companies into those health services in which a degree of privatisation already exists and for the purposes of TTIP the various UK versions of the NHS will be counted as one and because privatisation is already happening in England NHS Scotland would have to comply and allow private companies in.
      If Scotland were an independent country then that could not happen unless and until a Scottish Government decided to privatise parts of the service.
      However it’s somewhat unclear and a lot of lobbying is going on to allow any country to opt their health service out of TTIP but as things stand that allowance is far from certain or guaranteed.

    • yerkitbreeks says:

      No no, TTIP would apply to Scotland’s NHS if there’s a NO ; but with no already established privatisation in a YES scenario it would be exempt.

      • Anton says:

        Steve and yerkitbreeks:

        You both seem to think that there is no private healthcare in Scotland. That’s simply not true.

        Fact check. The majority of Scottish NHS Health Boards already use private health companies to supply a variety of services, and of the 160,000 healthcare professionals working for the NHS in Scotland 12,000 are engaged under private contractor arrangements. Last year the Scottish NHS spent more than £80 million on private healthcare provision, an increase of 37% since 2007 when the SNP became Scotland’s majority party.

        And, of course, the majority of GPs in Scotland are self-employed and hold contracts either on their own account or as part of a group. Their profits depend on the services they provide and how they choose to do so. In short, they’re already in the private sector. Taking GPs into account Scotland already spends not millions but billions of pounds on the provision of healthcare by private interests.

    • Steve Asaneilean says:

      Hi Anton – you are right to raise these issues as they needto be ddiscussed. But your analysis of the degree of privatisation in NHS Scotland is a bit fuzzy.
      It’s true that NHS Scotland outsource some IT, telecoms, social care, etc. They also make use of locum and agency staff. But that’s a bit like saying they employ private window cleaners to wash the windows. It’s not really the point.
      In essence GPs fall into 2 categories. PMS GPs are salaried employees of the NHS; GMS GPs are, as you say, technically self-employed but contract themselves in perpetuity to the NHS for the provision of NHS care. There are very few private GPs in Scotland.
      What is happening in England but not here is the wholesale competitive tendering of frontline services to be run by pprivate companies. That is what the big US companies want from TTIP and because it’s already happening down south the can push for more and can sue if blocked or if a future UK Government tries to reverse privatisation. But as I said it is still unclear and nothing will be settled for several years. But it is also clear from speaking to people directly involved in Europe that, in my view, the only current way to ensure Scotland is protected is to become independent.

    • Steve Asaneilean says:

      More on TTIP:-

      “Where competition already exists – i.e. in England due to the Health and Social Care Act 2012 – US companies can already provide services. There are concerns that proposed investor protection (IP) and investor to state dispute settlement (ISDS) aspects of TTIP could allow companies to sue the government for lost profits should it seek to repeal the Health and Social Care Act.

      As health services in Scotland are not open to competition, these mechanisms, nor any other part of the TTIP, are not expected to impact upon the provision of health services in Scotland. However, they could potentially be used by the alcohol industry to seek financial redress should minimum unit alcohol pricing (MUP) be approved by the European Court of Justice and implemented by the Scottish government.

      In addition, a relatively small amount of IT, telecoms and social care services are outsourced by the Scottish NHS. Any reversal of this outsourcing could also be potentially be challenged by US companies using the proposed IP/ISDS mechanisms”.

      Here’s a couple of useful links: the first is from February 2014 –

      And here’s another from June 2014 –

      However, it seems nothing final will be clear until at least 2016 and even then it may still get knocked back by European parliament so it’s all a bit in the air really. The only certainty thing is that if we were independent today we would definitely be exempt from competitive tendering for front line services.

      • Anton says:

        Steve – Many thanks for your wise remarks, and I readily admit that my previous post took a broad brush approach. In addition, and as I’m sure you know, many European Governments, including the UK, and indeed the EU’s chief negotiator, are publicly committed to excluding public healthcare from the provisions of TTIP.

        But I can’t see how you can conclude that “if we were independent today we would definitely be exempt from competitive tendering for front line services”. That claim rests on unknowns.

        I guess my main point is that the future of the NHS is not a sure ground for independence. There are better arguments.

        • Steve Asaneilean says:

          Agree Anton – the NHS is not the major issue for me either which is why my guest post didn’t mention it but instead focused on my main concern which is inequality.
          But we have to acknowledge that people do worry about it and we have to try and address their concerns.
          The reason for my assertion at the end is that just about the only thing that is certain about TTIP is that systems in which there is no established competitive tendering are exempt from TTIP already. As that is the case in Scotland just now if we were independent today we would be exempt. But, of course, nothing in life is guaranteed – except death, taxes and NHS reform 🙂

  25. jaffamcneill says:

    We need to get a simple message out there, we need focus, we need people to understand what they’re doing by voting no, so how about:

    Vote NHS, vote Yes!

    Surely that has a chance of getting through this currency claptrap, whereas essays and analyses do not.

  26. […] A guest post by Dr Nancy Burge Did you know that in England the Health and Social Care Act of 2012 made the most fundamental change to the English NHS in since its inception by removing the UK gove…In England entire NHS hospitals are being turned over to private companies. Healthcare services are now being split up into smaller chunks. An explosion of new private providers are waiting to cherry-pick the most profitable services ranging from mental health services, GP and Out Of Hours services, to diagnostics such as blood tests, x-rays and scans. Ambulance services are now being run by bus companies. No one really knows yet how the financially less attractive services will be run in the future. And how can we be sure that any of these services are being run for the good of patients rather than the profit of the shareholders?  […]

  27. Steve Asaneilean says:

    Good article by Lesley Riddoch on the issue of the NHS in the referendum debate here:

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s