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Medicine without frontiers

Posted on March 17, 2013 by

Recent claims made by Jackie Baillie (Labour’s shadow health spokeswoman and Better Together campaign director) suggested that Scots would be unable to gain access post-independence to medical treatment in England, because a Yes vote would lead to cross-border reciprocal healthcare becoming bogged down by red tape, complexity and costs, leading to treatment being delayed or withheld.


As we’ve explained before, given that reciprocal agreements already exist between the UK and other countries in the European Economic Area (EEA) – in the form of the European Health Insurance Card (EHIC) – Baillie’s claim is at its most generous interpretation an absurdly ill-informed misunderstanding, and in a more depressingly plausible scenario, an outright lie.

The EHIC agreement means that health cover is provided in each country and billed back to the relevant state (in either direction), meaning that member citizens can get healthcare anywhere in the EEA (including chronic ongoing healthcare for treatments such as chemotherapy and kidney dialysis). However this isn’t the end of the story.

Conveniently, the Scottish and English NHS organisations already have internal systems in place for allocating funding dependent on the place of residence for planned cross-border treatment (page 4). This system has to and does exist because NHS Scotland is completely independent from the English/Welsh NHS (and has been since its inception). This enables Scots to access specialist units that have been set up south of the border, for which no equivalent exists within Scotland, with funding provided by the Scottish government.

Since all the necessary mechanisms are already in place and functioning, there’s no conceivable reason why Baillie’s nightmare picture of an explosion of bureaucracy would ever occur. Nor should cost be an issue. While the rUK NHS would be free to change the prices it charged, that would an undesirable move (as we’ll see in a moment), and in any event if it remained cheaper for NHS Scotland to buy the service rather than replicate it, the supply of treatment from England would continue.

(In essence, for Scottish patients this would be no different to going to a private provider today.)

But why would it be undesirable for the rUK NHS to price Scotland out of using the services of specialists? The answer comes in the form of the ongoing NHS reorganisation and privatisation by Westminster. The NHS in England is being forced to build free-market principles and privatisation into the structure of how it operate and wouldn’t be in a position to turn down lucrative patient contracts with Scotland.

Scots would be clients to this part-privatised system and a source of additional funding to hospitals and medical centres involved. It therefore becomes in the interest of the English NHS to maintain access to specialist services so as to maximise the utilisation of specialist units and provide additional funding to support them.

Not surprisingly, the scare story on cross border healthcare has been condemned by doctors. One such doctor was consultant Izhar Kahn, a nephrologist (specialist in the diagnosis and treatment of kidney diseases) based at Aberdeen Royal Infirmary. Dr Khan has stated that cross-border medical treatment and co-operation would not be threatened by an independent Scotland saying:

“This appears to be nothing more than scaremongering. As a doctor, I do not ask if a patient is Scottish, English, Irish or Welsh. Doctors treat patients, not nationalities.”

Baillie had claimed that Scottish patients requiring specialist surgery in England would have to go through the same process as if they were travelling to another EU state, resulting in delays and medical costs paid by patients before being reimbursed. But that misses the entire point of the EHIC card for non-planned treatments, and also the fact that planned treatments outside Scotland would be funded by the Scottish NHS and agreed on booking.

Dr Khan went on to say that he had no doubt that after independence current reciprocal arrangements between Scotland, England and other countries around the world would continue to operate as they do now. There would be no reason to change them, given funding is already re-allocated under the existing provisions.

An independent Scotland would continue these arrangements for a number of very straightforward and sensible reasons – not least because these services are paid for and are extra-contractual. Money follows the patient from Scotland and the struggling NHS in England is not going to refuse lucrative contracts.

The rarity of some conditions makes it important for regional centres for such diseases to continue seeking patients in order to maintain their expertise, continue research and train future health care providers to manage them.

It is likely that an independent Scotland, with its fantastic track record of academic medicine, would develop facilities for heart and lung transplantation. There are already possibilities for this at the Golden Jubilee National Hospital in Clydebank.

I do not believe that current arrangements for transplantation and organ allocation will be affected in any way by Scottish independence. Attempts to cast doubt on cross-border arrangements between Scotland and England, and Scotland and other countries, seem like scaremongering to me.”

A recipient of the type of cross-border care in question also came forward to question Baillie’s claims. Vicky Pears, a care home worker from Lockerbie, was appalled by the suggestions and offered her own testimonial on how doctors in Scotland, England and Germany worked together to save her baby son from a rare, life-threatening condition.

Daniel Pears was diagnosed with congenital hyperinsulinism (CHI) when he was three months old, a condition so rare that there are only two specialist units for it in the whole UK. He was referred by the Royal Hospital for Sick Children in Glasgow to a CHI specialist unit at Royal Manchester Children’s Hospital, and within 48 hours was on his way by private plane to the Institute for Experimental Endocrinology in Berlin which had the only scanner in the world that could pinpoint the cause.

After the scan, he was immediately flown back to Manchester where the following day surgeons successfully operated. Mrs Pears said:

“’The doctors, nurses and support staff in all three countries all just got on and did what they had to do to help my child. Having to fly with my sick baby to Germany was a traumatic experience, but there was no fuss, no red tape and they all just got on and did what they had to do to help my child. They were brilliant,’ she said.

I want to make it absolutely clear that I am not making a political point – I am undecided about how I will vote in next year’s referendum – but these claims simply do not stand up to scrutiny when matched against my own experience.

I was not aware of any delay caused by bureaucracy or red tape, either south of the Border or in Germany so I cannot see any reason why that would change if Scotland became an independent country within the EU. It really looks to me that this a scare story put about by politicians.”

So what about all the red tape?

“When we got to Berlin I was asked to sign a form. It was in German so somebody had to translate it, but the paperwork took no more than 15 or 20 minutes and would have been even quicker had it been in English. The Scottish NHS paid for everything – the flights, the surgery and all the treatment. We haven’t had to pay a penny.

I just don’t think the doctors, nurses and hospital staff – whether in Dumfries, Glasgow, Manchester or Berlin – concern themselves about where a patient is from. They all just treated Daniel as a wee boy who needed their help and they couldn’t have been kinder or more caring.”

The Pears’ story is not an uncommon one either; most transplants are carried out in Scotland, although NHS Scotland block-buys heart & lung transplants and follow-up care for use by Scottish patients outside Scotland. In fact official figures show that in 2011, more than 5,200 patients from the UK received treatment in Scotland while 7,500 Scots were treated in England.

This long-standing arrangement for purchasing specialist care is a system also used by the Republic of Ireland, paying towards transplant centres in both England and Scotland. The cross-border purchasing scheme helped in the case of Becky Jones, a 20-year-old woman from Dublin with cystic fibrosis who underwent a double lung transplant at the Wythenshawe Hospital in Manchester.

Cross-border co-operation is very common and occurs all the time throughout the EEA. In the transplant field, a pan-European organ-donation network is being created to address shortages and short viability windows for transplants.

In a drive to facilitate the donation, transplantation and exchange of organs in Europe, the European Parliament voted on 19th May 2010 to pass legislation that sets common EU quality and safety standards for transplants. According to the new rules, EU member states must set up a national authority responsible for maintaining quality and safety standards for organs intended for transplantation.

These authorities will approve procurement organisations and transplant centres, set up reporting and management systems for serious adverse reactions, collect data on the outcome of transplants and supervise organ swaps with other member states and third countries. Spanish MEP Andrés Perelló, author of the parliamentary report on the action plan, said:

“A successful transplant system is not only based on the solidarity of the donors, but mostly on the right use of the information and a good network to share this information. We don’t want a person to die in Portugal, let’s say, because we never knew that there was a heart or a kidney suitable for him in France.”

The evidence above all suggests that there is NO threat to the provision of healthcare for specialist services after independence. Indeed, the only threat to the quality and provision of  healthcare in Scotland is posed by cuts from Westminster.

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  1. 29 05 14 22:38

    Ridiculous UKOK Claim of the Day #44 | mjaei

34 to “Medicine without frontiers”

  1. douglas clark

    Well that is another scare with it’s toes turned up. She really isn’t very good, is she?

  2. Adrian B

    Another great piece there Scott. You have once again pulled a lot of information from various sources together into one place. Concise message backed up with facts and examples will help to put peoples mind at ease.
    One really has to ask the question, what is in it for Jackie Baillie to lie and fib about such matters of importance as health? 

  3. RTG

    Interesting piece. Worthy of note however is that the NHS in Wales is every bit as devolved as its Scottish counterpart and is emphatically not being broken up and privatized as it is in England (in fact the 2007-11 Labour-Plaid coalition did away with the Thatcher-era internal market completely). Beyond that, keep up the good work.

  4. macdoc

    As a doctor myself I found this to be one of the most unpleasant scare stories of the bitter together campaign, the other being Johann Lamont stating that Alex Salmond was doing quite happy to let patients die of cancer because he didn’t want to fund the use of specific chemotherapy agents. This was perfectly rebutted by Joan McAlpine.
    How they manage to get away with such nonsense without journalists ripping them to shreds is beyond me. Does investigative journalism not exist in any sense in Scotland’s mainstream political media. 
    I can only hope that people very quickly become aware of the medias agenda. 

  5. Rev. Stuart Campbell

    RTG: That’s my bad, not Scott’s. Will fix later.

  6. The Man in the Jar

    @Adrian B
    at 12.26am.
    “One rally has to ask the question, what is in it for Jackie Bailley to lie and fib about such matters of importance as health?”
    I would have thought that that was rather obvious. She is an unprincipled barefaced compulsive liar. Who like all of her colleagues in her party and Bitter Together being bereft of policy and scruples and who is so blinded by hatred of the SNP & Yes Scotland that there is no depth that they will not stoop to. No subject to sensitive to lie about. Jackie Baillie is probably the worse of the lot of them. May I suggest that you type Jackie Baillie into the search box at the top of this webpage and see what comes up.

  7. Bill Fraser

    As an ex senior manager in the Scottish NHS I can assure people that cross border commercial contracts already exist between the English NHS. and the Scottish NHS which is a separate wholly Scottish organisation. Those contracts are negotiated on a commercial basis and benefit both the Scottish NHS and the English NHS because they allow the development of centers of excellence at the lowest cost by concentrating specialists in a facility that allows them to build experience in one specific specialty rather than in general practice. 

  8. seoc

    Desperate Labour politicians grasping for withering straws make desperate claims.

  9. Tris

    So as shadow health spokesperson she either doesn’t know about this, or she is lying, particularly in view of what Bill Fraser says (above).
    Which is it Jackie? Are you incompetent or are you lying?

  10. zedeeyen

    Last year, Mrs Zedeeyen and I, who both currently live in England most of the time, travelled back home for a visit. This visit lasted a bit longer than planned and Mrs Zedeeyen ended up running short of some medication, for which she has a repeat prescription. When we went to the local no-appointment health centre we were informed that English medical records aren’t available in Scotland because the IT systems are separate (or independent?), so if she wanted a prescription written out she’d need a new consultation with a Scottish doctor, which wasn’t possible in this case because it was a more specialist issue than a GP could deal with anyway. We then phoned her surgery in England to get them to send through a repeat prescription, and were told that this too wasn’t possible for the same reason. The only thing they could do was send her prescription to a pharmacy in Berwick or Carlisle and we could “pop” over the border to collect it.
    So it seems these issues already exist, and that the myth of a seamless, integrated NHS is just that – a myth. The two organisations are already separate and already operate under a system of cross-border agreements, except that right now they are totally ad-hoc. 

  11. Vronsky

    If it helps you to interpret people like Baillie, they have the following loyalties in the order given:
    1 Self
    2 Party
    3 The political class in general
    The numerous lobbyists who bribe sponsor them can be grouped under ‘Self’.  Their constituents figure nowhere on the list – they’re just a damned nuisance.

  12. Caroline Corfield

    I was musing on the problem of the prescription. What did you do in the end? Did you have to ‘pop’ over the border to pick I the prescription?  Perhaps this was a bit of a mess due to a lack of procedure but I reckon if you’d been directed to a local hospital they would have been able to write the prescription for your wife. A doctor would know better than me, but I think the problems you encountered are perhaps subtly to do with the fact that prescriptions are free in Scotland and there are numerous places where one could simply pop over the border to take advantage of this. It is possible that GPs can’t claim due to lack of mechanism, but I’m fairly certain that hospitals would be able to. I have used a dentist for emergency work in Scotland though I live in England, it was fine, mind they get paid by you at the time. In fact, I recall having masticis while visiting in Scotland and having no problem being seen by my mother’s GP and receiving a prescription for the anti-biotics. I’d be tempted ask follow up this incident and find out what went wrong because it sounds like some people were fobbing you off without real reason.  This would be no different to having this problem in France btw, a country currently independent from England, except in France you might have gone direct to a hospital.

  13. Adam Davidson

    But once again the claim is reported in the mainstream media as credible. Then the only challenge is on sites like this which is only seen by those who already understand, the damage is already done.

  14. zedeeyen

    I believe the problem stemmed from the fact that it was a repeat prescription for an existing condition. There was no problem seeing a doctor or having a new prescription written, the problem was accessing an existing prescription from over the border without having to be re-diagnosed in Scotland. Whether there was no mechanism to allow this, or the individuals we dealt with were simply unaware of the mechanism, I’ve no idea. There certainly could have been a certain amount of fobbing off involved, but as a patient you have no way of knowing either way.
    We actually resolved it by just going home early. This wasn’t the only factor in that decision mind you, just the one that tipped the balance. 

  15. Aplinal

    Indeed.  This is my increasing concern over the manipulation of “truth” by the MSM, especially the BBC in Scotland.  I understand the YES Scotland policy to stay clear of challenging the BBC as this would seriously divert the message into an all out attack on “CyberNats want to close down debate.  Fascist overtones etc. etc. etc.” ad nauseam. 
    I can also see the aim of making the real push in the final 16 weeks of the campaign, but how much damage would have been done in the meantime?  The constant message is that Independence is “TOO DANGEROUS” and this WILL be a subliminal “fact” that many, especially the “don’t knows” will have taken on board.  
    Bringing in an outside monitor is now a priority as far as I can see.

  16. Barontorc

    Whenever these untruths surface and it’s on record that this person Baillie is pretty much out in front in the lie stakes, a little worm runs around in my tiny brain waving a banner that says ‘Take Action’.
    If it’s said in Parliament, as many of these lies have been, by the same character, there seems to be a protective barrier and nothing of a punitive nature can be done about it, but what about when cynical untruths are put about, away from that protection?
    When damaging lies are the tipping point for say economic well-being of a national nature, can the government demand retraction under legal penalty?

  17. The Man in the Jar

    @Alpinal & Adam
    I agree with what you are saying completely. In particular regarding the BBC diverting the message into an attack on the SNP / cybernats. I can’t help thinking though. If the situation was monitored covertly by the ODIHR (and there is lots of evidence available already. Both on this sight, NNS and many others archives. Just to get them started) then if they announced the completed findings to the Scottish electorate the anger of the electorate would be so great that they would demand the truth.
    Perhaps that is the plan?
    I would love to see the BBC “news” presenter reading out the headline “Respected International body the ODIHR condemns the BBC for extreme bias in the run up to the Independence referendum”
    I assume that most will have read this article on Craig Murray’s blog if however you missed it the first time round take a wee look.

  18. Vronsky

    I picked up a prescription in France without difficulty.  I knew in advance I would have to do this at some point (I was taking a long walk through France and Spain) so I had a letter from my doctor.  I made a translation into French and handed it over the counter at a pharmacy in Gradignan, south of Bordeaux.  Done and dusted in ten minutes, no forms, no ID, no EU card asked for (though I had one) –  nothing.  Although maybe I was helped by telling them that I was on the pilgrim route to Compostelle, had a local priest with me and was staying at the priory?

  19. James Morton

    Saw this in the independent today which should focus minds a bit more.
    The sentence I had to read several times, just to make sure my eyes or brain had failed me was this:
    “According to the National Audit Office, Circle will make £31m over 10 years if it makes the £311m saving needed to clear the £40m debt.  The plan was criticised as “overambitious” by the Commons public accounts committee last month. ”

  20. MajorBloodnok

    Wow, always wanted to do that route.  Not that I’m particularly religious but I think a long walk from France into Spain over the Pyrenees would be fantastic.  And I understand that Santiago de Compostella is a beautiful town.

  21. Turnip_ghost

    Another good example of the half truths/downright lies the No campaign are using. The yes campaign needs to get this information out there. When spending time with friends yesterday one of them said “I see the SNP getting their ass kicked again about Europe” but when I tried to explain it he 1) wouldn’t listen and 2) kept conflating the SNP with the Yes Scotlabd campaign. 
    That being said, it’s hard to keep in mind that there will be people that won’t listen to the evidence and will believe what the MSN say. Frustrating as hell!

  22. Peter Mirtitsch

    Jackie Baillie has proven time and time again that she is nothing but an out and out liar, and TBH, not even that good a liar. I wouldn’t mind, but even when proven to be lying, she simply “forgets” the lie and tries to move on. People of Scotland are getting pissed off with her and her ilk. It would be so unfortunate if she is able to swing a “no” vote on the back of so many blatant lies. A number of unionists do this, but she is the one I have observed who does not  even try and be subtle about it.

  23. Robert Kerr

    I was seconded to Italy for four weeks from Kuwait. I was required to stay an additional four weeks to assist the project but had insufficient prescribed medication for my hypertension. I visited a pharmacy in Urbino and presented the empty packages. The pharmacy consulted a database and provided my medication for payment of about thirty Euros.
    No paperwork whatever !
    The big problem was my expense claim with my American employer but that is another story.
    Keep up the good work.

  24. Swello

    Really good piece.
    Given that the facts and opinions above are laid out in a methodical and non-emotive way, I’d be genuinely interested to see a rebuttal of this by Jackie Baillie in the same spirit. I’ve been hearing the “honest debate” line been trotted out a lot by Labour at Holyrood – would be nice to see that. It’s obvious by now that the vast majority of scare stories don’t bear any kind of scrutiny – so I assume she wouldn’t be too keen. 

  25. Rod Mac

    The problem is the same one ,even although WOS had brilliantly exposed  Baillie’s lie  in the MSM her lie remains unchallenged.
    Therefore the voting public still believe the lie to be the reality.

  26. Rev. Stuart Campbell

    “Given that the facts and opinions above are laid out in a methodical and non-emotive way, I’d be genuinely interested to see a rebuttal of this by Jackie Baillie in the same spirit.”

    The word you’re looking for is “astonished”.

  27. Vincent McDee

    The terrific news is: La Bailie is the “Better Together campaign director”
    We’ll be all put to shame, if we lose the Referendum with that kind of help.

  28. Barontorc

    If someone wanders about your neighbours telling porkies about you, you can get them for slander. So, what’s so different about dealing with with these duplicitous characters? Baillie has a noted reputation as a porky-pie-er, so when is it time to call it slanderous?  – When’s the time for zero tolerance against lies?
    It’s been raised many times, ad nauseum in fact, by all the opposition so-called leaders against whatever the SNP/SG does, but is never proven. Indeed, AS has reported himself for investigation on 7 occasions when his veracity was called into question. He has passed every such test.
    Where’s the ‘complaints book’ kept in Holyrood? If any utterance is untrue and not retracted it should be hammered.

  29. Desimond

    Maybe best be careful which images are used with Articles….Innocent till proven guilty of course but best to avoid giving opposition any excuse for a dig

  30. Vronsky

    @ MajorBloodnok
    I’m an atheist.  It’s still a great walk, and I still thought of myself as a pilgrim.

  31. Lochside

    Great damage is being done to the SG and the Scottish NHS by this Baillie woman. I recently lost a close relative due to negligence at the R.A.H in Paisley. The family are actively pursuing a case against the hospital. Despite this, I don’t buy Baillie and her half baked  mistruths. The RAH has been a disgrace for years prior to the SNP getting into power and Bailley and her crowd of miscreants had run down the Vale of Leven for years, making a population of approx. 20-30 thousand have to use the RAH across the Clyde via a single bridge crossing (tough if it was closed and you are having a coronary). No the SNP should get the crooked management sorted out in the various Trusts and hospitals, but who created the whole rotten centralised and crony-ridden mess over the previous 50 years?..Yeah we know who. As somebody said on here..every lie and distortion Baillie has made about the NHS should be thrown back in her ugly mug and she should be held to account in the Parliament, in exactly the same way as AS has been made to. Some kind of stand must be made against liars such as her. Otherwise the unenlightened will take the SG’s silence as admission of guilt. That’s the way it’s working with the people I meet. I’m afraid. 

  32. Tony

    My dad suffers from a very rare condition called Amyloidosis. He has to visit London every so many months. At present NHS Scotland pays for his flights and NHS England his accommodation and taxis at the National Amyloidosis Centre, Royal Free Hospital, University College London.

    Today his consultant in Glasgow told them a No vote is the only way to stop him from having to pay for his treatment. Going by what has been said above this would not be the case? I would appreciate if someone could help shed some light on this.

    My parents will be voting no and this will cement their vote, afterall to them a No vote is to vote against Alex Salmond, like most No voters!!

  33. Scott Minto (Aka Sneekyboy)


    Funding follows the patient.

    The Scottish NHS gets the bill from NHS England.

    There is no reason this would change.

  34. Yes Langholm


    Is there any official English NHS document that sets out exactly what the cross border health arrangements would be in the event of a Yes vote? A lot of local people here get treated in Carlisle, and it seems that in some instances they are being told by the hospital that they will have to go elsewhere should Scotland become independent. I know this not to be true, however, I am looking some information that does not come from the Yes side that puts this falsehood to bed. Any links or quotes appreciated. Ideally from someone working in the English NHS.


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