Our Wee Bit Hill and Glen

After the flag waving and songs, the bluster of economic pseudoscience, the bogus arguments about cultural differences, the dirty tricks of the financial establishment, and the genuine angst of people reluctantly empowered, we will on Friday 19^th September 2014 still have emergency departments in Scotland to run. And with either outcome, there may be trouble ahead in our NHS.

   If we wake up in the world’s newest nation state, we will surely enter a period of intense turmoil and uncertainty. It is very difficult to imagine that this will not lead to some damaging caution in health spending, at least until the financial industry takes stock and reboots itself. Of course, if the pessimists are right and the economy collapses, health funding might remain constrained for a very long time. Doctors may themselves begin to consider relocating to other areas of the world to avoid the turmoil and the distinct possibility of higher taxes. This drain of talent may continue indefinitely, as it is highly likely that the accreditation of specialists will continue to be recognised on either side of the border (such as now occurs between Australia and New Zealand), thus allowing easy economic migration in search of better wages and/or conditions in England.

  If alternatively, we wake to the confirmation of remaining in the UK, we have the distinct prospect of taking a hit in public spending following proposed

austerity-focused cuts in the rest of the UK through the Barnett Formula. Furthermore, the enactment of the TTIP could force the Scottish devolved NHS to open itself to overseas private competition, thus driving a parallel destructive orgy of privatisation to that of England. This scenario ends with a US style market driven health service that provides expensive, defensive mediocrity and gross inequity of provision. The loss of Scotland carrying the beacon for the retention of the NHS in its original and highly successful form, may also then consign the whole egalitarian principle to history; a casualty of the voracious appetite of global capital to make quick money without conscience.

   In either scenario, I worry about the grassroots effect of this political frenzy on running our departments, particularly in the urgent need to continue to fund improvement and recruit and retain excellent staff. Furthermore, I worry about the distraction from the very real world current problems of roster vacancies and overcrowding that are damaging patients and the reputation of our healthcare system.

   So, as a plea to both camps: come Friday morning, Scotland will have come through a major crossroads. As the dust settles, we still need to receive adequate continuity of funding to provide a level of healthcare as befitting this wealthy nation we are told we live in, whoever will be in charge. But also, perhaps given that health is an already devolved issue, and the government will continue to have tax raising powers whatever, how about taking advantage of all the talk from both sides about social justice and the importance and value of the NHS? Simply immediately put forward measures to increase top rate income tax by 1p in pound, remove the discretionary points system for consultants and use the resultant income to fund the expansion in rest home care places, chronic disease programmes, hospice care and 24/7 acute services necessary to banish overcrowding, bed blocking and boarding.

  It would be nice to have something concrete to show from what may be prove to be a very brief window of political engagement to improve the way we run things on our particular piece of ground.