Scotland will be spared Andrew Lansley’s top down reorganisation of the health service in England. Scotland’s Health Minister Nicola Sturgeon has said that there will be no more creeping privatisation of the NHS north of the border.

 And there are things that we can celebrate in the health service in Scotland - free personal care for the elderly and free prescription charges. 

 

But what we are not protected from is death by a thousand cuts. The Scottish Government’s budget is expected to fall by 12.5% (or £4.3 bn) in real terms by 2015. Health accounts for one third of that budget  and is supposed to be ring fenced. But last month UNISON announced that this year health cuts (not projections but actual plans approved by public bodies) will add up to £278m with job losses of 4,461. Cuts on this scale cannot be absorbed by ‘efficiency’ savings or by trimming excess fat. They will impact on front line services. The biggest cuts will be in Scotland’s biggest Health Board,  Greater Glasgow and Clyde where 1250 jobs are at stake. But comparable cuts are facing health services in Lothian, Tayside, Grampian and Highland. Moreover, public sector wages in Scotland are being frozen for 2 years. With inflation running at around 5% this means significant wage cuts for nurses and other health workers.

 

The arguments are well rehearsed. Health service costs are rising exponentially, patient demand is out of control and we can’t meet the costs of an aging population. The health service is wasteful and inefficient and doesn’t give value for money. The solution? We need to ration some services, introduce charges for other services, introduce health insurance schemes and bring in private companies who will run it more efficiently. 

 

Actually none of these statements are true, although they are repeated so often that some people are starting to believe them. An aging population does add significantly to costs as most people older people remain healthier into old age. The more serious illnesses just occur later. The health service is remarkably free from waste and gives fantastic value for money. It is private medicine which is wasteful - just look at the United States which spends almost twice as much as we do and gets far worse outcomes. 

 

We could easily contain the rising costs of the NHS drugs bill (15-20% of the total costs) by facing down the big US, UK and German drug companies who overcharge the Department of Health for drugs to subsidise their overseas drug prices. And we could scrap the Private Finance Initiative which doubles and sometimes trebles the cost of building new hospitals and represents a huge longterm drain on the budgets of hospitals. Britain still spends less on health than other comparable countries in Europe. There is nothing wrong with our health service in Scotland, Wales or England that more money would not solve.