Blog Post

In the final weeks, health care became key issue in Scotland's referendum

September 19, 2014

    Juliette Mullin, Senior Editor

    The people of both England and Scotland are very proud of their health systems. This pride was put on great display during the opening ceremony of the London Olympics, when nurses took the global stage to celebrate the National Health Service (NHS).

    So, as the Guardian notes, it was a bit surprising that the NHS had little role in much of the campaign for Scotland's independence. That is, until the last few weeks of the campaign, when it emerged as one of the top issues for voters and most heated arguments for both sides of the debate over whether Scotland should remain in its 307-year union with England. 

    U.K. wants NHS hospitals to expand overseas

    How independence would have affected Scotland's NHS system

    To offer some background:

    • The NHS operates as four independent systems in England, Wales, Northern Ireland, and Scotland. And Scotland's NHS has had operational control of its own health system since 1999, and it runs it very differently than England's system.
    • However, England currently sends Scotland a block grant for all civil services, including the NHS, and the Scottish government then allocates that spending.
    • If policymakers in England cut spending for the NHS—as they've been discussing—the block grant for Scotland will be adjusted accordingly.

    Initially, the fate of the NHS wasn't an issue that Scotland's leaders were discussing. (When the Scottish National Party released its 650-page white paper on independence last fall, the NHS was covered in just seven pages, according to the Guardian.)

    But Scottish officials began to argue that the UK's austerity measures, which have cut back public spending, affect Scotland's budget and thus funding for the NHS. "With independence we have the opportunity to ... protect public spending on the NHS and other key public services," according to the Scottish government. And that became the motivation for the "yes" campaign's biggest pledge: A public NHS that's free for all.

    Meanwhile, English officials countered that England's NHS changes would not affect Scotland's NHS and that only the Scottish parliament could make those types of changes to the Scottish health system. And some critics of Scotland's plan suggested the Scottish government already underfunds the country's NHS, and predicted a worse financial situation for the system if it left the U.K. Those critics accused the SNP of turning the NHS into a major issue in the campaign's last week to scare Scots.

    According to the Guardian, the "yes" campaign's focus on the NHS appeared to get through to voters. A YouGov conducted on Sept. 7 found that only 9% of Scots believed the NHS would improve if Scotland remained in the union, while 37% thought it would improve in an independent Scotland.

    Ultimately, the Scottish people voted to remain in the United Kingdom on Thursday night. So for now, the status quo remains. But U.K. officials pledged to give more powers to Scotland as part of the campaign.

    "The unionist parties made vows and Scotland will expect them to be delivered in rapid course," Alex Salmond said before stepping down as Scotland's first minister on Friday.

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