Saturday, 25 January 2014

The SNP would destroy what the NHS stands for

There’s something perverse about the SNP claiming to be the defenders of the NHS. The reason for this can be found in the letter N in NHS. When the NHS was set up in the forties it stood for something that would be available to everyone across the nation. But the nation that was being talked about was, of course, the UK. The people who created the NHS didn’t want a service that would only be available in England or Scotland. They wanted a service that would be available to everyone, no matter where they were from. It was for this reason that they called it the National Health Service.

Over time the NHS has evolved. Health is one of those areas that has long been devolved. We have a Scottish NHS, a Welsh NHS, a London NHS. These are devolved further into various trusts. But none of this really matters for the NHS is still national in the sense that it is something available to every citizen of the UK. It is available to me just the same if I’m on holiday in England or in Wales or in Northern Ireland. It still remains national in the same way in which it was created. It remains something British, something for all of us who live in Britain.

What the SNP are proposing to do is the very opposite of what the founders of the NHS wanted. They want to make the National in NHS apply only to Scotland in the same way that the National in SNP only applies to Scotland. Whereas the founders of the NHS had a vision of something that was available to every Briton, the SNP would like to break up the NHS, in the sense in which it was founded, and make it something that is no longer British but only Scottish. They want to create an NHS for the Scots, while the founders of the NHS didn’t think in those terms at all. After all, one of the reasons for setting up the NHS was that the British people had just suffered together through years of war and privation and no one cared much if you were Scottish or English, such distinctions mattered little when you had been fighting and dying together.

Had they been given the chance, would the SNP have set up a National Health Service in the forties? No, of course not, they would only have been bothered about healthcare in Scotland. But imagine if Nye Bevan had been a Welsh Nationalist and had only been bothered about healthcare in Wales. We would never have had an NHS at all. It was because he had a national vision, which extended beyond Wales that he was able to see that Britain needed a health service that would be free to everyone, no matter which part of the UK the person was from. It was because he was not a nationalist that Bevan was able to create the NHS.

It should be clear then that the SNP are not in the business of defending the ideals of the NHS, they are in the business of wrecking them. The NHS is a British institution and like every other British institution it would be destroyed by the SNP vision of independence. The Scottish NHS would of course continue, but it would no longer be part of the same whole, just as Scotland would no longer be part of the same whole. There would also be an NHS in the rest of the UK. But these organizations would share no more than the same initials. They would be separate organizations, with no more in common than the French NHS or the Australian NHS. That’s what it means when you change the meaning of the word “National” from British to Scottish.

I’ve no doubt that in an independent Scotland the Scottish NHS would provide us with excellent health care. But we would lose something and something quite special, which can be illustrated in the following way.  I heard a rather tragic story the other day about someone from Aberdeen who is really struggling with her health. She needs a transplant. Recently an ambulance took her all the way from Aberdeen to Newcastle, because there is a centre of excellence there in the type of care she needs. When a transplant organ becomes available anywhere in the UK, she will be flown to Newcastle by helicopter as will the organ. Our NHS is interconnected in ways that most of are hardly aware of until that time when we depend on an expert or a hospital somewhere quite far away in another part of the UK. What nationalists fail to realise is that it is because Newcastle and Aberdeen are part of the same country that we can expect cooperation like this to happen automatically. The SNP may try to promise that everything would stay the same if we voted to put Newcastle in a foreign land, but independence would change all our lives in ways that are hard to predict.

At present I can expect to obtain good and largely free healthcare throughout Europe if I fall ill on holiday. Moreover there is healthcare cooperation between separate countries like Britain and France. We can hope that these sorts of arrangement would continue in the event of Scottish independence and that we would get the same sort of treatment as a Frenchman gets currently in England. But the interconnectedness of healthcare which at present obtains across the UK does not obtain between Britain and France and over time is liable to be disrupted by Scottish independence. The reason for this is that such interconnectedness depends on our being part of one country, the UK. In all sorts of ways that we barely notice, our everyday lives are influenced by the interconnectedness that exists because we live in a single nation state, Britain. Whatever the SNP promises, they cannot promise that this degree of interconnectedness would continue for independence essentially is about creating a separate nation state. No two independent nation states are as closely interconnected as the parts of one nation state. Once this is understood, it becomes clear that Scottish independence involves the loss of something fundamental and something that we all take for granted. We might not even notice its loss until such time as we need it.


  1. I'm sure you think you believe you have a valid point, but it doesn't come across here.

    The NHS is safer in Scotland than it is in the rest of the UK, and will be safer in an independent Scotland.

    The matter of which nation the acronym originally belonged to is neither here nor there. And the Scottish NHS has always been a separate entity - not just since devolution.

    I can go to any European country and receive healthcare if I've applied for an EHIC. The same will still be true after independence.

    I now you're separate to find reasons to vote No, but this isn't one.

  2. Missed autocorrects there. I'm perfectly capable of spelling and using the correct words!

    1. I'm quite sure that in the event of independence we would still receive healthcare in England, just as we do in France and Germany. But you can't expect the degree of interconnectedness that exists at present in the UK to continue in the event of independence. It might continue for a while, but not indefinitely. That is true of healthcare and much else.

  3. Effie: There are all kinds of ways in which our two countries are interconnected. The NHS is actually rather less connected than, say, the National Grid or Air Traffic Control, or the various pipeline networks carrying chemicals hither and yon.
    I've never read anything - not even from the unionist camp - which has suggested that all the lights will go out or aircraft fall from the skies if Scotland becomes independent. It's common sense (and more important, self interest) that if an arrangement works well, it should continue.
    Unless the reform of the NHS south of the border reaches such a state where cooperation of the kind you outline is no longer practical, there is no reason whatsoever why the current system should not continue, with minimum modification. Currently, if a Scottish patient receives specialist treatment in Leeds, an invoice is submitted to NHS Scotland. There are already two separate systems in place - guidelines are different; drug approval is different - I won't bore you with examples.
    If I may say so, I think you misunderstand the debate. The independece movement is seeking ONLY political and economic sovereignty. It is not seeking to break up things that work well - just to have the right for Scotland to take decisions on its own account. That will lead to some things changing, of course. But common sense suggests that where things are working well, they will stay working well. Where is the reason why they shouldn't?

    1. I know that independence supporters would like everything to remain the same except sovereignty. My point is that many of the things that we take for granted and the interconnectedness that we have in the UK are a consequence of our being in one nation state. There is much more interconnectedness between Bavaria and Saxony, than between Bavaria and Brittany, even though both are in the EU. If Bavaria became independent it could not expect to retain all of the interconnectedness with the rest of Germany that it has at present. There are advantages to Bavaria being a part of Germany and therefore disadvantages to it seeking independence. The same goes for Scotland. No doubt many things would remain the same if we became independent, but I believe as a consequence of independence some things that work well now would work less well and over time would work still less well. I can not think of an example of a place which has become independent retaining the same degree of interconnectedness with the country that it left. Even the Republic of Ireland is much less interconnected with the UK than Northern Ireland. That is an inevitable consequence of it having chosen to become politically and economically sovereign. Over time it has diverged.

  4. Well indeed, over time things will doubtless diverge. But 'over time' is a fairly crucial factor in this particular argument, I would have said. To put it another way, for so long as remains in the interests of both parties to continue doing things together, they will no doubt do so. The only reason for the referendum is that we should have an equal say in what works - and we probably wouldn't be having one at all if Scotland felt it already had such a say.
    I'm not sure your appeal to different geographies works. Bavaria is part of a federal set-up (and I imagine - once we have the power to decide - a similar idea, or, better, a confederation, would be entirely acceptable to Scotland). If you go back to the debates over Irish Home Rule in the 1880s, you'll find Gladstone advocating what was effectively a devo max solution, because of his recognition that the interests of the Irish people were different and were not being catered for.

    With hindsight, Westminster missed a big opportunity in the 1880s, and equally - by refusing the third option - is missing an equally big one today. The problem as I see it, is that Westminster cannot see past the sovereignty of crown in parliament, and does not realise that if the peoples of these islands are to remain interconnected, a different constitutional solution is required.

    I trust that when Scotland votes Yes it will force a serious introspection on the London establishment, and may result in something creative. But I have my doubts, because I see no movement in that direction - quite the contrary.

    In essence, we of the Yes movement see an opportunity to do things differently. That does not mean that everything in the UK goes in some big bargain basement sale overnight. But you seem to think that any change - any divergence - is likely to be a diminishment. On the contrary, change can create as well as destroy. Who knows what will happen? But to argue that nothing should happen, because everything's hunky-dory as it stands is - if I may say so - a wee bit timid.

    1. I think your post is well informed and there is much I agree with. I would be more than happy if Scotland had a relationship to the the rest of the UK like Bavaria has to Germany. A federal solution strikes me as ideal. It was indeed an historic mistake that we didn't grant Ireland Home Rule.

      So you see there's not such a big difference between our positions. I tend to agree with the position outlined by Ambrose Evans Pritchard when he wrote recently:

      "The issue that matters is whether or not Britain can continue to be fully self-governing under the sovereignty of Parliament as long as it remains in the EU, or whether it should even be trying to so in a modern global world.

      It is about the proper locus of democracy, and whether or not the historic nation states of Europe are still the optimal organising basis for modern societies. All else is trivia."

      The same, of course, goes for Scotland. It thus may not matter in the long run which side wins in September. Short term you take your pick from which side of the argument you believe with regard to the economics.

  5. I agree. But the one crucial difference between us is that I consider that in order to make change happen we need to win the power to do it. You apparently don't (as yet!) Effectively, that's a Lib Dem stance...produce a few more policies on home rule and hope someone, sometime, will take them seriously.
    All I can say is that we have been waiting a long, long time.

  6. This entire post is based on a bizarre falsehood. There has *never* been any such thing as a single UK "national" NHS. It was set up, from day one, as two separate and independent organisations, by two separate acts of Parliament - the NHS Act 1946 and the NHS (Scotland) Act 1947.

    There are now three separate NHSes in the UK, plus an entirely different service covering Northern Ireland. Healthcare is in fact a perfect example of retaining the social union and co-operating across borders without the need for a political union. Indeed, the four UK healthcare services co-operate so seamlessly that most people don't even know they exist.

    You might find this article informative:

    1. Thanks for the link RevStu. The author puts his side of the argument skillfully.

      The people who were responsible for setting up the NHS in the forties were the Labour Government in Westminster. In order to do so they had to have separate acts, because Scotland has a different legal system. But it is quite clear that they intended the word National in NHS to refer to Britain and that is how everyone at the time did understand the word. It's also why, for instance, at the Olympic opening ceremony they used the NHS as something that expressed the nature of Britain. If the N in NHS (Scotland) Act referred only to Scotland, why didn't they just call it the Scottish Health Service? But because Labour were not a nationalist party they did not want to create an EHS a WHS a SHS and a NIHS, they created an NHS. It was one health service though divided into parts, just as we are now one nation state divided into 4 countries.

      One of the key issues in the debate is social union, as we all want to maintain it. I don't believe that it is possible to long maintain a social union without political union, for the same sorts of reasons as it is not possible to maintain fiscal/currency union without political union. No two independent nation states are as closely related or as interconnected as the parts of one nation state. If people are really concerned with maintaining the aspects of life in the UK that they like, they should consider voting no in the referendum, for it is unlikely that Scotland can achieve independence and thereby break the political union without breaking some other aspects of the social and economic union. Some of these may turn out to depend on political union.

    2. "If the N in NHS (Scotland) Act referred only to Scotland, why didn't they just call it the Scottish Health Service?"

      Because they wanted to create an illusion of unity where none existed. The NHS(S) wasn't just set up by a different act of Parliament, it was set up as a completely separate, operationally-independent body, and has been so for every moment of its existence.

      Why else would the NHS need a separate act when most acts of Parliament don't? Scots law has always been Scots law.

      We have a social union with the people of Ireland even though we haven't had a political one for the best part of a century. It's got far more to do with shared language and customs than it has with governments.