Healthcare should be free from markets, outsourcing and austerity
Health policy has been devolved to the Scottish Parliament since 1999 with the exception of a few areas such as drug licensing. Since then, there has been a significant divergence in the direction of travel between the different National Health Services across the UK, particularly between NHS Scotland and NHS England. Scotland currently spends 9% more per head on health and social care than any other UK nation and, while funding is not always the answer to NHS pressures, underfunding can create inefficiencies. The most significant difference is that NHS Scotland has maintained its unified, public structure, having abandoned the ‘internal market’ after devolution. Hospital and community services are run by area Health Boards which are now working with Local Authorities on the challenge of integrating health and social care.
In contrast, outsourcing under the Health and Social Care Act 2012 (HSCA) has fragmented the English system, replacing collaboration with competition. The contracting and transactional costs of this market waste billions of pounds every year and, along with Labour’s PFI legacy, have sucked funding from frontline services and driven NHS Trusts into debt: leading to the closure of beds, A&E departments and even hospitals. This has caused a marked decline in Emergency Care, with performance against the 4-hour A&E target consistently lagging 9-10% behind that of NHS Scotland. Similarly, the drastic reduction in hospital beds in England has led to patients lying on trolleys in corridors for many hours.
Due to financial pressures, common operations such as joint replacements and cataract surgery are being rationed by setting, what the Royal Colleges consider to be, unjustifiably high symptom thresholds. However, patients who are refused, can pay for treatment through the NHS ‘My Choice’ system as the HSCA now allows NHS hospitals to make up to 49% of their income from paying patients. Not only is this creating a two-tier health system in England but undermining the basic premise of the NHS which is based on NEED. If the patient needs an operation, the NHS should provide it without charge: if they do not, it should not be sold to them simply to generate hospital income! This is why I, and my SNP colleagues, support reform of the Health and Social Care Act.
Limiting public provision of these procedures may help drive a healthcare ‘market’ but it makes no sense in a comprehensive healthcare system. In Scotland, our aim is to increase provision of these procedures as, if older people can get out and about, they are likely to remain fitter and be less dependent on social care.
While the SNP removed prescription charges in 2011, they are still in place in England despite evidence they cause patients to cut back on their medication, increasing the risk of an acute exacerbation or hospital admission. Scotland is also the only UK nation to provide free personal care for the elderly which has now been extended to those under 65 years with a terminal illness or degenerative condition, like dementia. This policy, which Labour are now also proposing, not only allows people to remain in their own home but helps reduce the pressure on hospital beds and resources.
All four UK Health services face a new threat in the form of a US Trade Deal. President Trump and his officials have made clear that one condition will be to remove what they consider ‘anti-market’ practices such as central procurement and the cost-effectiveness assessments of new drugs carried out by NICE or the Scottish Medicines Consortium. It is estimated such changes could more than double drug costs, putting huge strain on NHS budgets. Such trade deals also pose a threat to public health as policies, such as the smoking ban, can be challenged if they reduce profit. If re-elected, I will seek cross-party support for a Bill to explicitly exclude the NHS from future trade deals and ensure that devolved governments have input to such deals to ensure their public services are not undermined.
Health is not just about the NHS and being free from illness, it is about genuine physical, mental and environmental well-being. Someone’s chances of a healthy life are mostly determined by policies other than healthcare, including education, housing, social security and, particularly, giving children a good start in life.
The biggest driver of ill-health is poverty, which increased the risk of almost every illness and reduced both length and quality of life. The biggest driver of poverty has been the austerity agenda of various Tory-led Governments over the past decade, which has left the poorest third of UK households almost £800 worse off on average, and driven children, pensioners and the disabled into hardship.
The Scottish Government is using its limited (14%) Social Security powers to protect the most vulnerable from the worst of the cuts, spending over £100 million each year mitigating the bedroom tax and providing crisis grants through the Scottish Welfare Fund. And, with child poverty rising across the UK and expected to affect 37% of children by 2020, they have taken targeted action to help lift children out of poverty with policies such as the Baby Box and Best Start grants. Increased early learning and childcare for all 3 and 4-year olds, making it easier for parents to take on work; while funding for low-income families to pay for childcare during school holidays helps tackle social exclusion and holiday hunger. Our aim is to level the playing field and reduce the need to spend money at a later stage – picking up the pieces of lives blighted by poverty, unemployment, addiction or crime.
As well as reducing the health inequalities that exist between different groups, the SNP are focused on prevention of many of the ills with which Scotland struggles. Supported by policies such as the smoking ban and the introduction of Minimum Unit Pricing on alcohol, Scotland is now leading the way in terms of measures to improve public health. However, the stubborn refusal of the UK Government to either reform or devolve drug policy is hampering attempts to tackle rising deaths due to street drugs.
The SNP believe in the principle that the health and well-being of their citizens should be the aspiration of every successful country. Improving the health of a population requires a pre-emptive approach with Health and Wellbeing front and centre of every government department together with a comprehensive public health system which is patient-centred.
Philippa Whitford has been an MP from 2015-2019, and is the Scottish National Party’s Shadow Health Spokesperson for the UK parliament.
With the UK now set for a General Election on December 12, Bright Green is publishing a series of articles from the spokespeople of progressive political parties on how their policies would transform the country. This article is part of that series – all articles can be found here.