This post is largely borne out of Doug Daniel’s open challenge (in a comment in a previous post) to find what Scotland’s next big idea could be.
The problem with big ideas is someone needs to come up with the ideas in the first place. What big ideas could the debate be focussing on? That’s the question. LIT is sure to feature, but what else could the parties be focussing on?
Doug is right to point to LIT (as well as renationalising rail, increased powers for Holyrood and independence) as potential big ideas for the coming election campaign but there is an element of raking over hot coals with each of these, to a varying degree. There must be areas for discussion out there that have barely made the light of day and are waiting to be explored (and if you are reading that as an open invite for a Guest Post then you have read it correctly – send any to editors@betternation.org (subject to quality control, of course)).
After a short racking of my own humble little brain, the best new idea that I can think of is as follows – an unashamedly 100% public health service.
The NHS is a tremendous institution with foreigners often visibly taken aback by the pride with which Scots and Brits defend it. While the current situation involves healthcare being free at the point of use and many who can afford it opting for private cover, what if the rules were changed such that it was not permissible to obtain private healthcare except for services that the NHS do not provide (I’m thinking plastic surgery or bespoke prosthetic limb provision)
I mean no more BUPA in Scotland and no private medical insurance. It would be a colossal change and a massive statement to make to the wider world about how a country could, and perhaps should, look after itself.
The advantages would be:
– a more consistent level of NHS services across the entire nation. There is a risk that, with the current situation, the more affluent areas of Scotland have poorer NHS options available as greater numbers are covered privately and there is insufficient funding for those that do require free cover. All parts of the country using one service will ensure an even spread of resources and an equitable level of service.
– Many of Scotland’s best doctors are lured into working for private institutions by the larger pay and bonuses available. That is not to take away from the expertise that the NHS currently has available but pooling all of our medical talent under one roof would ensure better access for specific needs for all Scots and less pressure on the remuneration of public sector doctors and health staff.
Many (of the many) detractors will say that if they can afford to jump the queue then they should be allowed to do so. Many will say that such a move will cost lives. Both are convincing arguments but if a continued public/private split of health cover contributes to a two-tier country and a widening of the gap between rich and poor then is this policy proposal justified nonetheless?
Nicola Sturgeon once celebrated a privately-run hospital “coming home†to the NHS. Could the Health Minister, or a parliamentary colleague from any of the parties, take this a few steps further and argue for private healthcare in its entirety being brought under NHS control?
There are no doubt considerable legal concerns with this move and Scotland would probably need more flexible fiscal powers in order to fund it more appropriately but, well, it certainly ticks the big idea box and that is perhaps what Scotland is crying out for.
Refreshingly radical or dogma gone barking mad?
#1 by Doug Daniel on November 17, 2010 - 12:21 pm
Ooh, I’m famous.
I’ll go for “refreshingly radical”, mainly because I’ve long held a similar view that private schooling should be brought under public control as well. I completely disagree with private healthcare, which is why if I’m ever offered BUPA membership as a benefit at a new job, I turn it down. It could probably be argued that people using private healthcare takes some of the strain off the NHS, but the very existence of private healthcare automatically means a reduction in standards in the NHS. Nobody pays for inferior services, so it stands to reason that for private healthcare to exist, it has to be taking away (some of?) the best doctors, nurses, dentists etc.
As I say, I’ve thought the same about private schools. How is it fair that just by going to a private school, a child is automatically given a much better chance of success in life than one from a state school? The children who go to private schools are no more naturally intelligent than those who go to state schools (I went to a state school, and I’m alarmed by how dense some of the privately-schooled people I’ve known have been), so why should they be granted an easier path through life just because their parents have some money? I don’t see any benefit in allowing children with less potential getting better schooling than those with great potential – if there must be a split of sorts, would it not be more sensible for this to be based on potential, rather than money? Who knows how many would-be rocket scientists, inventors and technology gurus we have languishing in state school classrooms full of unruly kids, struggling to get the attention of their teacher, who can barely keep control of the pupils? Meanwhile, the private classrooms are full of kids who wil never really be able to contribute much to society, but will still end up in some cushy management job purely as a result of a private education, leading to a place in a top university and a job with one of pater’s associates.
Everyone should have the same opportunities in life, be it opportunities to reach your full intellectual potential, or opportunities to live a healthy life. More money should lead to more luxuries, nothing else. We don’t have a separate, privately-funded police force or fire brigade for those with more money, so why should health and schooling be any different?
#2 by Anon on November 17, 2010 - 2:49 pm
Thankfully an idea that will never be taken seriously.
Last year I had a seriously fault with a hearing aid. The earliest NHS appointment was two weeks. That came around and turned out the person was not qualified to deal with my fault so another appointment had to be made – two weeks later. At the second appointment, the computer system had failed and they had no access to records (despite my issue being a simple that didn’t require accessing my records). So the appointment had to be rearranged a second time – yet again another two week’s wait. In all it took 6 weeks for the NHS to get round to making a five minute repair – meanwhile I was without any hearing at all.
When another fault occurred this year, I tried the NHS and was told to wait two weeks. I tried a private clinic who arranged an appointment for first thing the next morning. They took my aid away for repair and provided a spare in the meantime. Yes, I had to pay but compared to expense of being left deaf for weeks it was a price well worth paying.
The entire NHS isn’t bad – the paedriatic audiology clinic used to be superb. Incidentally, they used to contract the same private clinic to make all their ear moulds. They provided high quality moulds (made in Switzerland) and a quick turnaround – especially for children. Then somebody decided it was unacceptable to use a private service when there was a NHS service. Now the audiology department had to carry out the impressions (reducing the number of appointments available for other issues). The moulds were sent away to the NHS manufacturer – who repeatedly ignored the instructions as to type of material or design (not great for children), took much longer and eventually returned a mould that did not match the impression. Although they were cheaper per mould, it cost far more per patient as it took an average of three attempts to get a barely acceptable mould – once trimmed with scissors by the audiologist. Within months, the paedriatic audiologists were advicing parents to go back to the private clinic, now at their own expense, because the NHS service was simply not good enough.
As for private schools, many of the parents that send their children make sacrifices to do so – while their neighbours buy new kitchens, cars or holidays, they chose to spend their money on their child’s education. Abolish private schools and you won’t get the extra spending on educaton – not unless you take the money off the neighbours too. Meanwhile there simply isn’t the resources to bring every school up to level of private schools – indeed any attempt to do so would simply drag private schools down.
There should be a choice so that I can chose what is more important to me, not what somebody else thinks should be important to me. If I value my hearing more than the NHS does or want greater investment in extra curricular areas than the council believe in, then it should be up to me. It’s about freedom.
#3 by Malc on November 17, 2010 - 3:54 pm
To be honest, Jeff, I completely disagree. As much as I think the NHS is great, I think this is a crazy idea.
I disagree primarily from an ideological (liberal!) perspective. People should be free to spend their cash how they like – and if that means giving them the opportunity to buy healthcare which they think is better than the NHS (whether it is or isn’t) they should be allowed to do so.
But also, from a practical perspective, this wouldn’t work. The NHS is full to capacity at the moment already (see: waiting lists etc). Adding in all the folk who use private healthcare would simply grind the system to a halt.
As for your argument that doctors “lured into the private sector” would come back to the NHS for less money? How has that worked with universities in Scotland so far? As far as I can see, allowing universities in England to charge more (through top-up fees) than in Scotland has led to a “brain-drain” of talent from Scotland to England. Ban private healthcare in Scotland and our best docs will follow the money south of the border.
In short – ideologically and practically I’m opposed. But then, life would be dull if we agreed eh?
#4 by Cameron on November 17, 2010 - 4:54 pm
I actually went to a public (as in private) school and would like to make several things clear. These days state schools often have much better facilities, this is because whilst the council could afford to do PFI with new schools, public schools had to be able to pay for their new buildings on their own. So whilst state schools have fancy new glass builds, we had relics of the fifties.
I was in an English class in S1 and 2 that had 30 people in it, wouldn’t have happened in state schools.
The teachers weren’t better than state schools. There’s one reason and one reason alone that we got better results than people in state schools did. We worked.
Even if you weren’t naturally gifted (which seems to be who some people want to succeed the most), the fact you were in an environment where that was expected made you work.
I did the same exams in S4, S5 as people in state schools did. They were no easier.
And if you want to be hung up on potential then you should notice that schools with rich catchment areas to better than those with poorer ones too. Suggesting that having wealthier parents (i.e better educated parents) makes you more likely to succeed in school.
“but will still end up in some cushy management job purely as a result of a private education, leading to a place in a top university and a job with one of pater’s associates.”
Such a cliche, most private schools don’t have aluminus that closely knit. Most of us don’t have parents with “connections”, and those of us who got into good universities did so on merit.
Just because a few privately educated people are idiots doesn’t mean we all are. You could hardly say everybody from a state school is a genius.
#5 by Marcus Warner on November 18, 2010 - 10:45 am
Hmm. I side slightly with Malc, it would not be right to tell people they ‘cannot spend their money on private health’. They may wish to for all manner of reasons and do so while happily paying their taxes.
That said, One Wales has sought to end PFI in the NHS, which I think is fairly radical. We do have an issue regarding borrowing powers (the WAG cannot borrow), but it is the privatisation WITHIN the NHS that needs rid of, rather than private health IMHO.