The NHS in the Union: from its cradle to its grave?

yes_nhs_dennisBy Fiona Bowman – Fiona is a nursing student based in the North East of England and is a former National Treasurer and Vice-Convener of the Federation of Student Nationalists.

Well doesn’t time fly! Only one month to go until Scotland votes on whether or not to become an independent country. One of the main discussion points at the moment is the future of our National Health Service, something I would like to touch upon here.

As a future NHS worker I do think there are real fears over the outlook of the National Health Service. Firstly, no-one can deny that all institutions need to continually evolve and face the modern challenges of the day. We should also recognise that conditions now are vastly improved from the decades and centuries past. But I live in England and when I sit in my local doctor’s surgery I’m baffled every time I see the prescription charge up on the pharmacy wall, which currently stands at £8.05 per prescription (due to increase to £8.25 next April). It makes me question the society we live in. I keep a quote from Aneurin Bevan, the Health Minister responsible for establishing the NHS, on my desk to remind me of the inequalities that still exist today. It reads:

‘My heart is full of bitterness. For when I see the well nourished bodies of the wealthy, I also see the ill and haggered faces of my own people.’

I like this quote as it gives me a constant reminder of one of the reasons why I wanted to be a children’s nurse; to give every child in our society the best opportunity of a healthy and happy start in life. After recently spending time in the community on placement, I have also developed an interest in public health nursing. It is here you get a real sense of the inequalities that exist in society, going from visiting families in privately owned new builds to mould-ridden council houses (which the NHS cite as a trigger of childhood asthma). But this is also where I’ve seen the ways in which government policies and investment can make a real impact on living conditions and wider social determinants of health, such as providing better housing and safe community playgrounds for children to play in. Government intervention can make a difference and I believe we can make more effective interventions in an independent Scotland.

No-one can promise that in an independent Scotland health and social inequalities won’t exist, but it is about reducing the ever-widening gap. Since the Black Report in 1980, successive Westminster governments have failed to deal with the widening health inequalities that exist. It is true, however, that health inequalities can not only be solved through improved healthcare. Indeed, the Marmot report in 2010 (commissioned by the Department of Health, England) put forward the argument that health inequalities emerge from social inequalities indicating that governments have a deeper-rooted problem to solve. Through these types of reports over the decades it has been asserted that there needs to be an overhaul of how inequalities are tackled and funding put in place.

This has not been happening in England while the union undermines our attempts to do this is Scotland. An independent Scotland would give us the opportunity to radically change how society deals with health and social inequalities. By having the constitutional and financial capabilities to commit to substantial transformation of health and social care provision, Scotland can build a fairer and healthier society.

This, in my opinion, cannot be achieved by staying in the union. Through the Barnett Formula, reduced public spending in England means reduced public spending in Scotland. This could directly impact on the health budget in Scotland resulting in cuts to services. More than that, I don’t believe that Scotland in the Union can withstand what will become a growing ideological pressure to follow the trend of privatisation south of the border. The collectivist ideology that may have existed within the Labour movement when Aneurin Bevan introduced free healthcare in 1948 does not exist today and shows no sign of returning.

An example of the routes being undertaken by the NHS in England includes NHS foundation trusts (which we don’t have in Scotland) competing against each other for services. This has been seen recently in the North East of England with children’s heart surgery services between hospitals in Leeds and Newcastle. I understand the need for specialist centres, for example Great Ormond Street, who can care for rare cases but I do not think reducing the availability of this type of surgery in regional areas benefits families. Major hospitals can already be a fair distance away from the family home, so to then make the family travel an extra 2-3 hours would be a detriment to their experience. Currently nursing focuses on two main approaches, holistic nursing and family centred care, and I believe that privatising the NHS and reducing availability of services it makes it harder for the NHS to deliver these approaches. By increasing travel time this may force families to be split up for lengthy periods, especially if the child requires substantial recovery times. Parents need to compensate for many things including work and childcare for other siblings. Scotland has an opportunity to protect the NHS from this reduction of services and privatisation. The level of free healthcare currently provided in Scotland can be guaranteed, but only by the inclusion of this principle in a written constitution of an independent Scotland.

Protecting the NHS in Scotland is only one reason I believe in an independent Scotland. The other key reasons for me include removing nuclear weapons from the River Clyde, returning a government that Scotland votes for through a proportional voting system – not the out date first past the post Westminster system – and having control over our own finances and ultimately our own destiny.

Hopefully this is not new to anyone but it is important to emphasise that this referendum is not solely about the NHS, currency or even Alex Salmond and the SNP. It is about each and every individual voter questioning what kind of country they would like to live in. Vote for the country you would be proud to live and work in. Vote for the country you would be happy to bring your children up in. Vote for the country you would be proud to call home.

I’ll finish on one of my favourite and inspiring slogans of the campaign:

If not us then who? If not now then when? Vote Yes on 18 September 2014.

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