With September 18 drawing nearer, the people of Scotland still lack answers about how independence will affect a number of institutions, policies and their everyday lives. It is crucial to uncover what impact independence might have on Scotland’s health care services, and its internationally renowned research systems.
In order to pinpoint the most relevant issues in the referendum debate, researchers from Edinburgh’s Innogen Institute spoke with representatives from the health sector. These included people from the academic, clinical, and commercial life science sectors, as well as governmental and charitable funders of clinical research.
The ‘sick man’ of Europe
Since devolution in the 1990s, Scotland has modelled itself as an asset for healthcare, medical research, and clinical studies. Scotland’s population is stable, relatively uniform, and generally willing to participate in research. It is also one of the sickest populations in Europe, with all major chronic diseases represented.
At the same time, Scotland has a very strong research capacity, thanks to its highly skilled workforce in the life sciences. This country also has excellent links to patient records, disease registers, and tissue banking facilities.
Scotland’s governance and approval systems are arguably more streamlined and efficient than those in the rest of the UK. Mix all these factors together, and you come up with a country that is both the “sick man of Europe” and a “living lab” with real opportunities to improve health and conduct world class medical research.
Understanding the status quo
There are many different views about the benefits and limitations of the existing devolved health care service, and the complex partially-devolved research system that has developed alongside it. To make an informed decision about Scottish independence, we need to understand some of these details.
Despite Scotland’s medical prowess, the Scottish Government’s White Paper on independence includes a relatively small section on health, social care, and the NHS. The narrative is very positive, aiming to reassure the public that access to NHS services will not be drastically affected by a yes vote.
Devolution has allowed Scotland to avoid the major NHS restructuring that has happened in England and Wales. As a devolved country, Scotland has proved capable of operating a relatively cohesive health system, with efficient and streamlined governance.
It has also been able to exploit the advantages of being a smaller country – for example by implementing fully electronic patient records – though this may have happened in any case. Even so, it’s likely that devolution has sped up some of the changes in the policy and structure of the health service, to better suit Scotland’s specific needs.
The risks of ignoring research
There is a positive association between the maintenance of a strong medical research system, and the quality of health care in the clinics where it is located, according to many of the people interviewed for this research. Governments ignore this link at their peril. Yet the white paper on Scottish independence says very little about the potential impacts on medical and clinical research.
The promise and delivery of a self-governed health care system, alongside a thriving research network, will come down to funding. But government funds are not the only source of support for medical research. As a “living lab”, Scotland has the opportunity to expand its implementation of commercial clinical trials, which are still a relatively marginal activity.
This is mainly because of the attitudes about toward commercial versus non-commercial clinical studies within universities, hospitals, and the NHS more broadly. For some, commercial studies are less important than academic studies. Others feel that Scotland is not pursuing the commercial side as aggressively as it should. Further groups see the opportunity for a middle ground, where the NHS creates dedicated commercial units in hospitals, which then fund and drive research.
Research Councils UK
Despite the potential for an increase in commercial research, Research Councils UK (RCUK) is still a crucial source of funding, and will probably shape decision-making among commercial and third sector organisations. So perhaps the most critical uncertainty in the debate about Scottish independence relates to the potential loss of money from the RCUK.
The white paper proclaimed that under independence, Scotland would continue to pay into the RCUK pot and draw funding from it on a competitive basis, with Scotland and the rest of the UK considered a single research area. But the UK government has claimed that Scotland would not have access to these funds, and that independence would be “very likely” to undermine the favourable distribution of research funding to Scottish universities. This has rightly caused great concern.
It is clear that Scotland needs to be a part of a single UK research area, regardless of a yes or no vote. It would make sense for an independent Scottish government to have various routes to medical research support. It would also benefit from the ability to control funds for local needs, and access open competition schemes.
A single research system would also benefit the rest of the UK, as large competitive research systems are much better than smaller ones. On top of this, major pharmaceutical and device companies are generally more inclined to invest in a fairly consistent systems.
So, is Scottish independence bad for your health? It may seem like a dramatic question to ask, but its fundamental to our future. Citizens of Scotland should have the answer before they head to the polls in September.
Elisabeth Barlow and Professor David Wield also contributed to this article, which is part of Innogen’s research on the ESRC Future of the UK and Scotland project, The Future of Scottish Health Care and Research.