Scotland's shift away from a commercialised NHS to one based once more on solidarity is proving highly popular with the public.
Since devolution, the NHS in Scotland has taken a very different path to that of NHS England. It has embraced co-operation rather than competition. And new figures show that Scots reckon that it delivers for them.
Findings just released from the Scottish Social Attitudes Survey (SSAS) 2013 have found satisfaction with Scotland’s NHS increased by over 20 per cent since 2005. The official survey of around 1500 Scots found that 61 per cent of people in Scotland were either very or quite satisfied with the NHS, compared with only 40 per cent in 2005.
This high level of satisfaction is reflected in the patient experience as well. In last year’s Health and Care Experience Survey, 85 per cent of Scottish inpatients say their overall care and treatment was good or excellent, and 87 per cent also rated the overall care from their GP surgery as good or excellent too.
The findings contrast with a reduction in UK-wide NHS satisfaction levels since 2011. Comparisons must be made with care - but the survey authors speculate that the different trend may be due in part to concerns about the changes in the English NHS following the introduction of the Health and Social Care Act in 2012.
Scots continue to reject the commercialisation of care, both in hospitals - where few have ever wanted the private sector or even charities running things - and in care services.
Private sector involvement in the NHS may be minimal in Scotland, but it is common in the social care sector, particularly residential and home care.
Most (59 per cent) thought the government would provide better quality care services than the private sector. There has even been a drop in support for charities running care services.
Scotland’s approach to health care organisation has cross party support. There is little difference between the SNP and Scottish Labour positions.
Rather than having lots of fragmented trusts competing with each other, one of the first actions of the newly devolved Labour administration in Scotland was to halve the number of NHS trusts in Scotland from 47 to 28. Susan Deacon, the first health minister, left people in no doubt that the market was not the future for health care in Scotland. The NHS was no longer put under pressure to offer the private sector the chance to run NHS services and they started to come back in house.
In 2001 Malcolm Chisholm took over as health minister. Chisholm completed the reform process with the NHS Reform Act of 2004. This Act formally abolished trusts and established a duty of cooperation. This radical policy was viewed as the right approach for a country the size of Scotland and more in keeping with Scottish collectivist traditions. For this reason it was maintained even when New Labour implemented market based reforms in England.
The SNP administrations since 2007 have continued this approach. In 2009, they made it unlawful for health boards to contract with private companies for GP services.
Not everything is perfect. One area of private sector involvement common to both administrations has been the use of expensive PFI schemes. Even if this is driven more by financial considerations than ideology. Scottish health ministers have always used PFI reluctantly but the application of the block grant and no devolved borrowing powers led to PFI being ‘the only game in town’ approach that remains to this day.
Politicians in Scotland will therefore take comfort from the latest survey that the political consensus against the marketisation of health services has broad support amongst people living in Scotland.
Whilst it’s for voters in England to decide the future of their NHS, polls suggest that most people in England don’t want a privatised NHS either. Scotland’s NHS demonstrates that a better way is possible and popular.