It is a mark of how important social democratic values have become to Scotland’s independence debate that when Alex Salmond kicked off the last month of referendum campaigning he put saving the National Health Service at the top of his list of the benefits of leaving the UK.
“The only guarantee – the only certain way of protecting our precious, publicly funded NHS – is independence,” Mr Salmond told an audience in Arbroath on Monday.
Mr Salmond has good reason for focusing on health. The NHS with its principle of free care at the point of need is hugely popular in Scotland – and many Scots are troubled by reports of the “privatisation” of the system south of the border.
“Yes” campaign strategists believe that if voters are persuaded that an increased private sector role in the English NHS would hurt Scotland’s health budget they are much more likely to back independence on September 18.
The sense that the NHS symbolises social policies that are diverging from those pursued in England also offers an argument for Scottish independence that resonates far beyond traditional nationalists.
Declaring his support for independence at the weekend, the eminent Scottish historian Sir Tom Devine cited Scotland’s commitment to the social democratic values that created the UK’s postwar welfare state.
“It is the Scots who have succeeded most in preserving the British idea of fairness and compassion in terms of state support and intervention. Ironically, it is England, since the 1980s, which has embarked on a separate journey,” Sir Tom told The Observer.
Yet Mr Salmond’s focus on “saving” the NHS is not without political risks. Pro-union campaigners are quick to point out that Edinburgh has enjoyed full control over health in Scotland since the creation of the Scottish parliament in 1999.
And the vision of looming health system disaster if Scotland votes “No” next month hardly fits with the positive arguments for independence that the first minister has said will win over undecided voters.
Malcolm Chisholm, a Labour member of the Scottish parliament and a former Scottish health minister, has dubbed the Yes camp warnings “the big lie on the NHS”.
“Those who have sanctimoniously criticised the No campaign for negativity [have] showed that they are in a class of their own in the scaremongering stakes,” said Mr Chisholm. He argues that health reforms in England do not imply a removal of public money and Scotland will always be able to choose how it runs the NHS.
A recent analysis by the Nuffield Trust think-tank found that the performance of Scotland’s devolved NHS had improved relative to that of England – although it credited better management of waiting lists rather than the decision to largely reject competition and to offer all patients free prescriptions.
Yes campaigners insist that if Scotland remains within the UK, it will always be vulnerable to changes of English spending policy that would affect the block grant transferred from the UK budget.
Continued spending cuts and austerity in the rest of the UK would spell a squeeze on Scottish health. And any change to the “Barnett formula” used to set the block grant could further undermine Scottish spending.
But independence would also bring with it fiscal restraints, particularly given the reliance on revenues from declining North Sea oil and gas reserves.
All health systems are facing the same mismatch between demand and resources. Scotland, with its patterns of ill health and areas with some of the lowest life expectancies in the UK, can hardly escape difficult choices.
Mr Salmond is hardly alone in playing on NHS-related concerns, however. Pro-union campaigners including former prime minister Gordon Brown have suggested independence would threaten cross-border co-operation on organ and blood donations and the ability to send patients to access specialist services in England.
Yet there would continue to be advantages to both countries in pooling efforts on blood and organs – and in an era of cash constraints, the English NHS would be unlikely to refuse referrals as long as Scotland continued to pay for them.
● National Australia Bank, owner of Clydesdale and Yorkshire banks, on Monday became the latest company to warn about a Scottish Yes vote, saying independence “may give rise to significant additional costs and risks for Clydesdale Bank. We continue to closely monitor the situation and have appropriate contingency planning in place.”
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