Monday, 25 August 2014

NHYes: Part 1

If you’re sick or thinking of becoming sick, it’s been an interesting few days in the referendum debate.  

The Scottish NHS, previously noted for being clamped to a giant spinning wheel in BBC Scotland’s knife-throwing sideshow, was thrust centre stage as the shining star of Alex Salmond’s Second Declaration of Arbroath.  It instantly became a certainty, barring the discovery of another massive secret oilfield, to produce the mother of all rammies in 2014’s other big Holyrood sequel, Great Debate II.
“Scaremongering!” spluttered the dismal Unionist chorus, twisting their faces into a lame impression of The Scream and hoping the wind wouldn’t change. To be fair, they do own the exclusive rights to the politics of fear, so they may have been over-egging things in the hope of getting away with a claim for royalties.  Jim Murphy’s balloons and Irn-Bru crates don’t come cheap, although he’s usually able to skimp a bit on amplification.

It’s heartening, albeit weird, to see official Yes representatives generating a flash of brimstone, instead of sheltering under a blue and white umbrella, smiling meekly as the No campaign poo-chucking brigade lets fly.  But, frankly, it’s not all that controversial to predict a financial squeeze on the basis of the UK Government’s declared NHS policy affecting a pre-determined funding formula with “Consequentials” in its title.  Even if it were, it would be an angel’s kiss compared with Better Together’s lurid tales of the Four Horsemen of the Apocalypse rampaging through Mrs McIntosh’s front garden if she even thinks about putting her cross in the Yes box.

Scottish Labour politicians, eagerly lapping up their daily Conservative Central Office briefings, seem to be under the impression that all is hunky-dory with the NHS in England.  Presumably they believe the modern-day Jarrow marchers are a genetically programmed long-distance walking club.  And no doubt they regard the concerns expressed by their own Shadow Health Secretary at Westminster, Andy Burnham, as his adolescent neurons getting in a tizz because he’s overdosed on Coco-Pops and 7-Up.

If a Tory shakes your hand, it’s only to draw you closer so he can knee you in the groin. So when in 2010 the incoming government trumpeted the ring-fencing of NHS England spending, there was a soul-sucking sense of inevitability about the subsequent squandering of truckloads of dosh on a cack-handed, bulldozing reorganisation that they’d specifically ruled out before the election. The pathetic Lib Dems, mere novices in the art of lying in manifestos, or at least in being found out, could only gawp in admiration as they stood holding the Tories’ jackets.

The Health and Social Care Act 2012, which should have been sub-titled “Payback Time For Our Chums Who Bought Shares In Healthcare Providers”, opened up a whole new vista of exploitation for private suppliers.  Smirking wretch Jeremy Hunt and his successors no longer had a legal obligation to provide universal health care in England, so there was no point in suing them, although the Coalition took the precaution of also knee-capping Legal Aid, just in case.  On the positive side, the NHS postcode lottery was open for business, if any thrill-seeking punks felt lucky!

The hyperactive world of Twitter went into a ferocious ferment, but the BBC felt queasy about upsetting the government before charter renewal, and the press couldn’t find an embarrassing celebrity angle, so the public remained blissfully ignorant of the privatisation earthquake.  They could still visit their GP without some cadaverous accountant eyeing up their credit card, and the NHS branding remained in place, like a modesty blanket covering up embarrassing naughty bits, so they didn’t realise that the smiley practice nurse who’d always looked after their foot problems had morphed into a stressed-out, demoralised operative of Bunions R Us plc.

The elephant in the room, which is now wearing a pink tutu and threatening to tap-dance, is that the caring imperative and the profit motive are uneasy bedfellows.  If you’re a typical rapacious capitalist bastard, how can you resist the temptation to skimp on non-essentials, such as the well-being of the patient?  Before you know it, you’re sending woozy post-operative customers home with a one-size-fits-all “DIY care package”: a small brown bag containing two tabs of Anadin, the address of a local pharmacist, a lapel badge saying “Mustn’t Grumble” and, in extreme cases, a pearl-handled revolver.

And in a world where corporate troughers just can’t get enough gold bath-taps, how long can the “free at the point of use” principle survive?  Some think tanks, presumably populated by piranha fish, are already mooting prices of £10 or even £25 for a chat with the local quack. 

Or how about introducing charges for A & E, if the triage nurse deems your injuries to be your fault because you’re a trifle pished?  If people can’t afford them, no doubt some smarty-pants entrepreneur will step into the breach with self-help booklets such as How To Remove An Axe From Your Own Head, Gangrene: Pros And Cons and 101 Uses For A Severed Arm.

So far, so grotesque.  But how does all of this affect Scotland, which, as indignant windbags on the Holyrood opposition benches keep reminding us, has had control over its own NHS from the outset? 

Naturally, I'm simply itching to tell you, but as it's a contentious issue, with steam constantly whistling out of Better Together's ears, I'd better go and put on some Kevlar first, so let's take a comfort break.   Off you go, make a cup of tea, have a smoke, rearrange the Yes stickers in your window, block a couple of people on Twitter and then feel free to come back and join me for the answers in Part 2 right here.


  1. Excellent explanation of why a YES vote is vital to save OUR NHS.

  2. The Health and Social Care Act 2012 is about the ENGLISH NHS, not the Scottish NHS. Since devolution, Number 10 and the UK Parliament have no control over Scotland's NHS.

    However, there is a bigger issue, and Scots Nats have their head in the sand over this. At the moment the Tory UK government is part of the EU negotiation of the TTIP treaty. Scotland is not a member state of the EU and is not part of this negotiation, the UK government is negotiating on behalf of all UK nations. After Sept 18, regardless of the vote, Scotland will still not be a member state of the EU, and even if there is a Yes vote it cannotbe a member state of the EU until independence in 2016. The TTIP treaty will be signed in 2015. Once the agreement between the EU and US has been made the agreement cannot be changed. iScotland will have to decide whether it is in TTIP or out. Salmond will take iScotland in, and he will take the Scottish NHS into TTIP on the same terms as English NHS.

    So what will TTIP mean? Well contrary to what the SNP and Cyber Nats have being saying, TTIp is not restricted to services already open to competition. Unless a service is explicitly exempted (like the French Film industry) TTIP will be applied to *all* public services. That means that a US corporation (or, indeed, a EU corporation) will be able to challenge why a public services is being delivered by a state owned organisation. The problem is that the complaint will not be handled by the courts, it will be handled by a panel set up by TTIP specifically to privatise services.

    The Scottish NHS is not safe from TTIP. Independence will not make it safer, indeed, since iScotland will be so small and insignificant (compared to say, Germany), independence will actually make it more likely the privatisers will win. Indeed, only if iScotland works with a Labour-run England can TTIP be fought, but it would be far better, and far easier to fight TTIP if the UK is not fragmented.

    Of course, a privatised English and Scottish NHS is exactly what the Tories want. A UK parliament without Scottish Labour MPs is exactly what the Tories want. Everything Alec Salmond does is exactly what the Tories want. Sometimes I wonder what party he leads.