Wings Over Scotland

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.