Scotland must not be forced to follow England’s path to a sick society


by Hazel Lewry

The path to a sick society in England is being engineered through a combination of a democratic deficit – they have no independent government like the Scots, Welsh or Northern Irish – and the intrinsic desire by Westminster to grandstand far beyond its means on the international stage.

Our cousins south of the Wall should understand that it’s all about money. Nuclear weapons and illegal wars, or health care. Whitehall knows the UK can’t afford both and Westminster has made its choice very clear.

Westminster would much rather maim and kill in other nations than heal and preserve human life at home. That is the only interpretation the actions of that sad parliament allow.

In the bluntest of terms, Westminster has become a pox on the English people, a pox that must not be permitted to spread elsewhere, for like any contagion it will surely try.  

Not only have Clegg’s, Moore’s and Alexander’s Liberal Democrats failed to stand by their written pledge to the students of the UK, as Tory bedfellows they have categorically betrayed the needs and desires of an entire electorate, for who would believe the electorate would vote for even partial NHS privatisation.

Scots should understand that Westminster is trying to force the same tactic in Scotland by the simple expedient of real reductions in the “block grant”. For those few who don’t know, Scotland’s block grant is where Holyrood is handed back some of the money we give to Westminster each year.

Last week, the NHS in England was effectively set up for privatisation.

The bill didn’t call itself “the NHS England Privatisation Bill”, but that’s effectively what it is.

It provides a driving impetus to the creation of private ownership of NHS facilities. Westminster is broke and needs to raise cash. Since selling England’s forests didn’t work it seems the politicos south of the border may have found something even more lucrative.

Sell the NHS. It’s not specifically worded, packaged or sold to the electorate in England as such, but that’s the probable ultimate impact.

Then after selling the NHS, fund what you sold and its profits through the public purse.

The problem with assets is you can only sell them once. Brown discovered that as he squandered the gold reserve to help pay for Blair’s Iraq war. If you sell an asset and still need the service, well there’s a wee bit of a problem in future costing. You must pay the price the buyer sets.

Is private medicine such a bad thing? It seems to provide better, faster care – if the hype is to be believed. The lobbyists would have us believe it’s fantastic.

Perhaps I have a better insight than many: firsthand experience of health care in several countries, including Scotland and the USA.

The NHS in England will eventually now be largely run by doctors’ groups, by international consortiums and by private companies.

For a time it appears they will bill the state, at least partially. Very shortly thereafter expect the state to realise it can no longer afford the increased costs required to generate private profit.

Each organisation will need its own support staff, its own billing. In time each will send its lab needs, its laundry, its purchases and requisitions to private companies without the benefit of any significant economy of scale. All these separate contracts need to be created, reviewed and administered.

They generate no additional intrinsic wealth for the economy; instead, they are yet another internal group of service industries intent on sucking the lifeblood from England’s already anaemic body.

Every independent surgery or doctor will have to chase its own accounts. The debt collectors, courts and lawyers will be kept very busy indeed, perhaps even busier than the doctors themselves.

As the potential impacts of this legislation work their way through the system each practice or medical group will need to start having a positive balance sheet as quickly as possible.

Staffing levels will bloat like they have in America, and they’ll need to be paid for. As Michael Moore, the US filmmaker of “Supersize Me” fame, tweeted after the bill’s passage: “The British parliament has just passed a bill ‘reforming’ their universal health service – so it could be more like ours. A sad day 4 Brits.”

Someone will have to pay for all this. It won’t be Westminster; Westminster’s broke.

Look for the “encouragement to go private” for “new” healthcare insurance to quickly raise its head.

In time expect commercials, advertisements, billboards and all the other aspects of private industry to creep in and create an incredible healthcare postcode lottery based on a combination of location and ability to pay. Nike or Reebok? Sheffield Children’s or Alder Hey Children’s? Or none if you’re uninsured/uninsurable.

Expect the lobbyists to focus on Holyrood next.

It’s as simple as that. In time it’s likely you’ll pay your money and make your choice – or your insurance will. And if the best care isn’t available in your insurance group or under “your policy”, well to put it bluntly you’re pretty much toast.

Private medicine isn’t about people, it’s about profit. Period.

If the insurance company doesn’t authorise it, you don’t get it. The decisions will be slowly but surely removed from the doctors.

I remember hearing of an uninsured woman who died a year or so back in the waiting room of a New York hospital. Staff walked around her body and left it lying for quite a while until someone thought to “clear up the mess”. That one made the internet; most don’t.

Then there are issues about exactly what private policies will cover. If your illness isn’t covered, you’re bankrupt and destitute, or dead.

Personal experience tells me there’s not much of a halfway house, mostly because dead is much less expensive, and if the corporation, including the government can get away with it, dead is what happens.

Allow me to give a case with which I’m very well acquainted. A person believes they have the best of health insurance; it’s never failed them in the past under the very rare occasions it’s been needed.

One day there’s a well witnessed accident in the line of duty – they’re rushed to hospital. The hospital refuses treatment because the person’s policy statutorily doesn’t cover “work injury”. They’re “made comfortable” until the hospital hears from the employer. The individual is stabilised, if possible.

The employer has to agree to accept the cost. It’s a Saturday. Limited treatment is eventually authorised, but it was a poisoning, so any delay is critical.

The employer then realises the employee will survive but be permanently disabled, which has the potential to be expensive in the extreme. So the employer authorises a couple of tests designed to “prove” it wasn’t an employer-related injury and thereafter takes the “low-cost path” and denies liability – even that the incident happened at all. The mandated health records are “lost”.

The “company” doctors this employee was sent to apparently somehow “missed” the fact that the individual concerned could no longer walk straight, stand and close their eyes or even write their name. The individual concerned had been pre-eminent in their field nationally and internationally.

This was the employer’s standard default position: “discredit, delay, deny, and hope they die”. US$60,000 as a single payment death benefit is far less expensive than a lifetime support. If the patient survives long enough and can be “fired for non-performance” or because sick leave expires, then one could be off the hook completely.

I’ve also heard it said “couldn’t happen here” to many of these issues. The average American is also appalled at these incidents, but they’re also impotent. A bit like foundation hospitals “couldn’t happen here”.

In 1975 had someone suggested privatisation of the NHS the chorus would probably have been loud indeed: “Couldn’t happen here.” Ditto Holyrood or an SNP majority. Times do change.

Then there’s that ultimate insurance caveat, “maximum lifetime benefits”. In the USA it’s normally around US$2 million. That means if you are in a severe car accident as a teenager, you might well use up a lifetime of healthcare insurability before you’re 20. You might make a full recovery, but if you need your appendix removed at age 25, you’d better have the money ready – or face penury.

Of course you could always just opt to die and not bankrupt your family.

Pre-existing conditions must also be considered. Many find themselves uninsurable. Under these situations you live as long as you can pay if you get ill, then the state steps in with limited care in a smaller number of facilities – until you eventually die.

It’s the individual doctor’s choice to accept state levels of payment or state-funded patients after all. Many, perhaps most, don’t.

This then is the path Westminster is dictating that England walks. England is being forced to sleepwalk into a healthcare future that will work very well for the healthy and those who don’t need it.

It will work very well for the extremely wealthy. Those like the bankers amongst us who get seven or more figure bonuses and won’t miss the odd few hundred thousand pounds.

It will not work for the vast majority. A vast majority who are unlikely to see their National Insurance reduced as they are forced into private medicine. Westminster will increase its tax take in yet another stealth move.

When money selectively enters medicine, as it can easily and predictably be interpreted from the above that it will, society is truly on the path to being sick.

I’m not suggesting for one second that the ultimate in care should be provided to every individual that comes along; no society can afford that.

Every individual in any society does have a right to expect a basic level of care which might be available to anyone else in that society at any level.

In the ultimate analysis, it is how we care for our sick and disadvantaged, our disabled and elderly which truly define us as a society, or at least as a society of any worth. By these very significant measures the respective societies are already very different both sides of the Tweed.

For those of us who think it couldn’t happen in Scotland – and I’ve had a few tweets to that effect – they should well remember the only way to possibly stop it is independence. Until that day the purse strings are controlled by Westminster. And if Westminster squeezes hard enough, the NHS in Scotland will have to give. There will be no option.

They should also remember that Westminster has demonstrated a severe allergy to different levels of basic service across this dis-United Kingdom, and that Westminster will actively work to create a reasonably level service delivery through any geographical area it believes it can influence, and I include Scotland in that. They should also note the baying of the southern media has already started.

The present round of Westminster-imposed cuts is resulting in a forced merger of all our own nation’s fire and police services. The savings will still not cover the cuts. The social impact will be significant. There isn’t much fat left to trim in the allocation of Scotland’s pocket money.

The NHS is our premier untouched national asset, securely resurrected and ring-fenced by the SNP, but it’s built on the foundation of quicksand that is Westminster’s now ever-reducing block grant. That fence has the definite potential of disappearing under Whitehall’s fiscal onslaught through the coming years.

Anyone who expects NHS Scotland to survive unscathed, intact and in its present form through the upcoming rounds of cuts that are already in the pipeline from Westminster is an individual I would describe as disassociated from reality. If allowed, Westminster will have its way with Scotland’s health service, or something else will be devastated to maintain NHS Scotland.

The problem is that as a nation, Scotland’s running out of “something elses”.

As Westminster drops deeper and deeper into the financial abyss of probable bankruptcy, that day of reckoning between social Scotland and socially divided England is drawing ever closer.