This week the people of Scotland will decide whether to end the country’s 300-year+ political union with England and the rest of the UK. As a Scot without a vote – owing to my residence in England – I’ve been watching from the sidelines while the debate has swirled around fundamental issues such as currency, the economy, EU membership and defence.
Healthcare – in particular, the NHS – has also been a key issue. This is despite the fact that, in the short-term at least, day-to-day healthcare provision will be unaffected, as the NHS and wider healthcare policy are already fully devolved to the Scottish Parliament. In addition, the Scottish Government intends to continue using the MHRA as medicines regulator, which should hopefully prevent a divergence in medicines regulation and access (imagine the absurdity of a medicine being deemed safe for OTC distribution in England but not Scotland …).
One can only guess how independence could affect health provision in Scotland in the long-term. Scotland currently enjoys higher NHS spending per head of population than England, while the Scottish Government has introduced flagship policies such as “free” prescriptions and personal care for the elderly (there’s nothing free about it of course, as patients pay for it through taxation), which it claims will be maintained if Scotland goes it alone. Opponents have questioned the affordability of such policies, casting doubt on the pro-independence camp’s estimates regarding the income it will receive through oil revenue and job creation.
What is clear, no matter which way the vote goes, is that Scotland will continue to face some strong public health challenges, with life expectancy remaining below that of the UK average for both men and women. For example, a report earlier in 2014 stated that Glasgow – Scotland’s largest city – has lower life expectancy than most of the developed world, with 25% of boys born there expected to die before the age of 65, owing mainly to poor lifestyle. Perhaps we’ll never find out how an independent Scotland would tackle these problems, but ultimately all that matters is that they are tackled.