Scotland referendum 2014: the impact of independence on the NHS
Analysis of the potential impact of a Yes vote in the Scottish independence referendum on health services and the NHS.
Part of a collection of articles produced by the House of Commons Library which explore the potential impact of a Yes vote on the UK, aiming to inform the debate from an impartial viewpoint.
Scottish independence would not affect the day-to-day running of the NHS or how people access health services in Scotland or the UK, since independent services already operate in Scotland, England, Wales and Northern Ireland
Despite its name, the National Health Service has never operated as a single institution across the UK
The Scottish Government has said that independence will allow it to tackle the wider determinants of ill-health, but there could be an impact on cross-border co-operation
Currently, medical training and employment conditions in the NHS are standardised across the UK, but they may diverge following independence
The NHS today
Since devolution there has been substantial divergence in health policy between the different parts of the UK, with Wales and Scotland abandoning internal market reforms and the role of competition increasing in England.
These diverging paths create a laboratory for policy comparison but the evidence for how the NHS in each home nation has performed is contested, with each model having its own champions and critics.
The National Audit Office report, Healthcare across the UK "A comparison of the NHS in England, Scotland, Wales and Northern Ireland", finds variations in health outcomes across the four nations, and the Nuffield Trust report, The four health systems of the UK "How do they compare?" suggests that services are improving across the UK, despite very different health policies.
Health Foundation chief executive Jennifer Dixon has commented “no one policy cocktail seems to be more effective than another on NHS performance.”
National boundaries within the UK do not represent barriers to the provision of healthcare. People living in border areas are able to register with GPs on either side, and patients are able to be referred for highly specialist treatment or surgery anywhere in the UK.
Arrangements for some blood supply and organ transplant services also operate across the UK.
While the Scottish Government argues that these cross-border arrangements would continue unchanged in the event of independence, there have been some questions about this.
The BBC article Scottish independence: Clash over cross-border healthcare claims highlights concerns raised by John Lamont MSP over the fate of cross-border healthcare in an independent Scotland.
Medical education, NHS workforce planning and pay and rules for charging overseas visitors are all closely aligned across the UK.
Having broadly the same (or very similar) training, job titles and pay structures for healthcare professionals in each UK health system facilitates mobility across the four UK health services.
The current system of regulation for medical professionals also allows licensed doctors and nurses to work in all four countries of the UK without the need to re-register with separate regulatory bodies.
While these arrangements could continue, the British Medical Association (BMA) article Scottish independence referendum and its implications asked whether current policy co-ordination would be maintained if there were an independent Scotland.
Examples of international co-operation
There are examples of international co-operation in the delivery of health services within the EU that could provide a model for future healthcare agreements between an independent Scotland and the UK.
UK and Ireland
There is an agreement exempting UK and Irish nationals from having to carry European Health Insurance Cards to access services when visiting their respective countries.
There are increasingly well-developed patient rights to access cross-border healthcare under EU regulations but these are currently little used.
The Department of Health has published guidance on the implementation of EU directive on patients' rights in cross-border healthcare.
However, these will not replace the need for government-to-government co-ordination of health services, whatever the outcome of the referendum in September.