I am being asked on Twitter by some followers for a personal guarantee that the Scottish NHS won’t be in some way destroyed by Westminster following a No vote in Thursday’s referendum.
I’m not convinced I’m the right person to ask, given that I am a writer, not a politician. But it seems to me to be pretty obvious that the only group that can destroy Scotland’s already ropey NHS is the Scottish government. Why? Because management of the NHS has been completely devolved to Scotland for many years.
The money Scotland spends on its NHS comes from the Barnett Formula. Whenever funding rises in the UK, Scotland gets a proportionate share which it can spend on devolved services (of all sorts) as it likes.
The Scottish government does not have to use private providers just because the UK government does, nor does it have to spend any particular proportion of its block grant on the NHS.
Clearly, spending cuts across all of the UK mean that the block grant gets cut too (albeit by rather less than total UK spending thanks to the Barnett Formula). But that again doesn’t mean that Scotland has to cut spending.
It can either reallocate money from other areas to the NHS or use its tax raising powers to reject at least some austerity for Scotland.
Under the Scotland Act 2012, the Scottish Parliament will be responsible for stamp duty, land taxes and 10p in the pound of income tax and can raise or cut rates at will.
A 1% rise in income tax would do the trick (bringing in something like £400m). I am told that this would mean “the Scottish would pay for the NHS twice.” But this is numerical nonsense.
If Scotland wants a better/different NHS that costs more than the UK one, why is raising the tax to pay more for it paying twice? It is surely just paying for the extra.*
The whole point of budget cuts is to keep current and future taxation in the UK down even at the expense of some services.
Devolution, and the Scotland Act in particular, mean that Scots have a choice about whether to go along with this: if they want to spend more than the rest of the UK, they can raise the taxes to do so.
So, there you go. Only Scotland can cut the budget of the Scottish NHS and only Scotland can introduce privatisation to the Scottish NHS.
Readers who think Scotland is different might like to note that it has already done both. England has been raising spending on the NHS even as it faces real budget cuts in other areas. But Scotland, despite its older population has not.
From 2002/03 to 2009/10, spending rose 43% in England and 29% in Scotland in real terms. In the years 2009/10 to 2015/16, it will have risen another 4% in England and fallen, yes fallen, 1% in Scotland (Institute of Fiscal Studies).
Those numbers tell you that Scotland is already using its discretion as to how to spend its block grant – as it has been able to for many years now.
I mention the cuts above, but the priviatisation is there too: the Greater Glasgow and Clyde health board has recently outsourced its obesity work to Weight Watchers, an American-listed company.
* One of the best double-speak conversations of my referendum so far has been on how privatisation might mean a fall in the block grant. Surely, I was asked, “privatisation will mean the NHS budget in England falls?”
“Why would it do that?” I replied. “Privatisation doesn’t mean the private sector pays for the NHS. It just means the NHS pays private companies to do its job. The idea is to make it better value”.
“But if it works, then the NHS in the UK will cost less and we will get less money.”
“OK, I say, let me get this straight. Your worry is that privatisation will make the NHS better and less expensive, so you want to avoid it at all costs?”