Many people in England are unaware that the NHS in Scotland (and in Wales and Northern Ireland) has always been a separate organisation. The Scottish National Health Service was set up by the NHS Scotland Act in 1947 and today in 2014 is a very different NHS compared to that in England.

The Scottish NHS abolished the internal market in 2004 and brought back area health authorities. Nowadays the NHS in Scotland is again about co-operation, not competition. There are no trusts, no secretive commercial confidentiality considerations, no fragmentation of services, no wasteful and costly commercial transaction costs for tendering services.

Given the cuts and privatisation that are now afflicting the English NHS as a result of the Health and Social Care Act, it’s worth looking at how NHS Scotland works, since this offers a good model for restoring the English NHS.

This would give us something to tell the politicians, who are all now busily gearing up for the 2015 General Election.

Paul Cooney, of Huddersfield Keep Our NHS Public, mentioned this at a recent Calderdale and Kirklees Joint Trades Council public meeting about the NHS, and said that the Labour Party should take on this Scottish model of the NHS.

This sounded like an interesting idea, so Plain Speaker asked him to write about it.

Here is Paul Cooney’s brief account of key stages in the history of the Scottish NHS, working backwards in time so the most recent events are told first.

Today NHS Scotland is a good example of illustrating that if the political will is there then the NHS can be changed back to be more in line with its original founding principles as laid out by Nye Bevin in 1947.

It is based on cooperation, not competition and has abolished the purchaser/provider split.

As such, of course, it poses a danger to those who believe that neoliberal market economics are the way ahead.

NHS Scotland consists of 14 Regional NHS Boards which are responsible for the protection and the improvement of their population’s health and for the delivery of frontline healthcare services.

In addition there are 7 nationally based special boards such as the Scottish Ambulance Service and NHS National Services Scotland which looks after blood transfusion, health protection and information and 1 Public Health body, Healthcare Improvement Scotland.

Scotland has free prescriptions and free personal care, unlike England.

There are serious concerns that the privatisation which is marching ahead in England will be forced through in Scotland, through funding pressures from the Westminster Government.  It is one of the major topics of debate in the Independence referendum campaign.

2004 The National Health Service Reform (Scotland) Act, abolished trusts, which were absorbed into health boards. The Act completed the process of abolishing the internal market in Scotland. Health boards are now the single tier of governance and accountability. New Community Health Partnerships are established with resources and decision making power to work with boards and involve patients and a broader range of staff in their work.

1997 Scottish NHS White Paper stresses longer term planning and integration of services

1997 “Designed to Care” was published. This Scottish White Paper set out the new Government’s stall for phasing out the internal market and with it GP fundholding and contracting for services. The tone of policy is different in Scotland, which stresses longer-term planning and integration of services as opposed to England, which encourages a range of health care providers and a modified version of the market model.

The 47 Scottish trusts are merged into 28. Local Health Care Co-operatives are created to bring local services together and managed clinical networks are promoted to co-ordinate treatment from family doctor to specialist diseases such as diabetes and heart disease.
Governmental control of health becomes entirely under the control of the Scottish Parliament, albeit funding is still from the Westminster block grant.

UK NHS White Paper introduces competition and health services market

In 1989, the most fundamental change to the National Health Service since its inception brings in the idea of competition and a market for health services. The UK White Paper Working for Patients sets out the policy which sees patients more as consumers and introduces an “internal market” with separate purchasers and providers of services.

New NHS Trusts have their own autonomy as providers and they can negotiate with health boards who commission services. GP fundholding is another feature of this system, whereby family doctors have budgets and can buy services from trusts.

Advocates of the internal market claim it would make the NHS more efficient and responsive to patients. Opponents say it simply adds another layer of bureaucracy and does not run with the Scottish tradition of an integrated NHS based on co-operation not competition.

5th July 1948 was the vesting day of the NHS across the whole of the UK.

Highlands and Islands Medical Service- the forerunner of the UK NHS

In 1912, the Highlands and Islands Medical Service was set up. This was the forerunner of the UK NHS – a state-funded, centrally-controlled, comprehensive health service. It was born of necessity as poverty was widespread in the Highlands and Islands and health provision was limited. A committee was appointed under Sir John Dewar to examine the problem and its findings were stark. It recommended Government grants be paid to doctors on condition that they treat those in need and charge minimal fees. In practice, this often meant free treatment. The Highlands and Island Medical Service was slow to get going because of the First World War, but once up and running, it provided an outstanding service which was copied by other remote communities across the world.

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Paul Cooney