The Health of Nations

I’ve been watching the twisty-turny passage of the NHS bill through the Commons and Lords, with horror mixed with relief. The devolution settlement means that the Scottish NHS is not subject to the same privatisation, and although as with other international struggles, I offer my solidarity to the people of England who are about to be robbed of their NHS, fundamentally I figured it wasn’t really my fight.

Only then it got personal.

As this post on Edinburgh Eye points out that Scots travelling to England may not get emergency treatment on the NHS.  Indeed under the provisions of the bill, the clinical commissioning groups (CCG) are not required to provide the following services except to people who actually live in their area

  • Accident and emergency services and ambulance services
  • Services provided at walk-in centres
  • Facilities and services for testing for, and preventing the spread of, genitourinary infections and diseases and for treating and caring for persons with such infections or diseases
  • Medical inspection and treatment of pupils
  • Services relating to contraception
  • Health promotion services
  • Services in connection with drug and alcohol misuse

There has been some discussion over the exact provision of A&E  and it would seem that Clause 12 of the bill does cover emergency services to people living outwith the locale, however how “emergency” is defined is likely to be determined by the CCGs.

There are so many questions over this bill that it brings into question whether Scots visiting England will require heath insurance to be assured that they will get the care they require should they fall in while travelling – will companies with an English presence have to provide health cover for their staff should they require them to visit or indeed work at one of their English operations?  What is the situation of pregnant women who go into labour while visiting England, or have health complications related to pregnancy – are these covered as part of routine ante-natal care, or excepted as a walk-in service.   Moreover there is the situation of English people travelling to Scotland: with waiting lists likely to be extensive for treatment unless you are prepared to go pay to go private, could we see an influx of the ill coming from the south to be treated from within our budget with no recompense for the Scottish NHS?

Within other countries in Europe there is a reciprocal healthcare agreement in place – whereby the health service of the country that the national of another is visiting provides treatment under similar conditions to the arrangements of their home country, charging the home country for the treatment.  Scots can travel throughout the EU with a E111 card, confident that should they become ill or injured they will receive treatment.  While we are part of the union however, the differences in provision between England and Scotland will be considered a national anomaly, and consequently not one in which the EU can intervene.

Within the Union we are placed in a situation where our revenue is being used to subsidise the profits of private companies making money out of the misery of the sick and injured of England, while we are left in limbo should we visit.  There is a damn good case for the Scottish NHS becoming a competitive provider of services in England.  At least then the profits made would be reinvested back into healthcare, however there is another risk with the NHS Bill.  Under EU competition legislation, companies could argue that the Scottish NHS is anti-competitive and demand access to that market.  This is currently being poo-pooed as pie in the sky, however exactly the same thing happened with BBC Jam; a scandal of monumental proportions which was completely hushed up.  I suggested at the time that such a ruling had a serious impact on the government provision of services – questioning whether BUPA could complain that the NHS is damaging its business – with a precedent set south of the border and within the same legal jurisdiction, the Scottish NHS is vulnerable to a similar legal challenge.

The NHS Bill must be stopped, not only for the people of England who are in the frontline, but also for the rest of the UK, who will suffer the fallout.

First published on Bella Caledonia – 12th March 2012

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