The Scottish National Party’s manifesto makes relatively few pledges on health. This is, of course, because policy on health care and the NHS in Scotland are devolved to the Scottish parliament, and are essentially none of Westminster’s business. The UK parliament can affect the overall budget for the NHS, and could amend the formula used to distribute funds to the four constituent governments, but they cannot influence how NHS money is spent in Scotland.
There are major differences between the NHS in Scotland and England. In Scotland the purchaser-provider split has been abolished, and health boards are responsible for planning and delivering services. Prescriptions are free, personal care is free for over-65s, and guidelines on new treatments are provided by SIGN, not NICE.
These differences should create opportunities for well-designed evaluation and policy analysis. But in practice, efforts to undertake such studies have been “plagued with difficulty” due to data collection differences and political reluctance. Perhaps, as so often in relation to political reaction to policy evaluation, there is “safety under the cloak of ignorance”.
The balance of power
The manifesto highlights differences between Scotland and the rest of the UK, but also shares priorities with some of other parties, like the Liberal Democrats. There is a focus on health and social care integration (£300 million over three years for an integrated care fund, and £30 million for telehealth), and on mental health (£100 million for an innovation fund over five years), including investment in child and adolescent services.
But these and other policies outlined (including investment to tackle delayed discharges, and more specialist nursing care) would not be delivered by the SNP in Westminster, but in Holyrood.
This manifesto, which aims to “make Scotland’s voice heard at Westminster”, includes only two substantial pledges that could be delivered by the UK parliament. The first is to protect NHS Scotland’s finances, increasing NHS funding across the UK by £9.5 billion above inflation. This, the party says, will deliver an extra £2 billion to NHS Scotland by 2020-21. This presumably assumes no change in the allocation of NHS funds to Scotland, which is still based largely on the Barnett Formula.
The Barnett Formula was intended as a short-term expedient in 1978, and has been repeatedly criticised ever since. As far back as 1980, Scotland’s NHS was reported to be over-funded by around 15%, largely at the expense of England. More recently, a House of Lords Select Committee report described the formula as “arbitrary and unfair”, on the basis that it has not taken account of changing population levels and economic needs.
The SNP also commits to “vote against any further privatisation of the NHS in England and back any moves to restore it to a fully public service”. As it stands, SNP MPs at Westminster can affect the English NHS in ways that English MPs cannot affect NHS Scotland. There has already been political tension over proposals to introduce “English votes for English laws” (EVEL).
Policy that’s good for you
The manifesto also includes a number of commitments which, while not influencing health care, may have the potential to influence population health. The strategy to reduce emissions, with ambitious targets for carbon reduction, should directly benefit respiratory and cardiovascular health. Pledges regarding in-work poverty, child poverty, affordable housing, job creation and supporting unpaid carers all have the potential, at least in theory, to influence social determinants of health.
Given the poor health profile of Scotland in comparison with other European countries, and stubborn health inequalities within Scotland, this focus is to be welcomed, particularly as there is evidence that deprivation is only one part of a complex picture driving “excess” mortality.
The manifesto also highlights public health policies already implemented in Scotland aiming to reduce reduce alcohol and tobacco consumption, promote physical activity, and remove financial barriers to treatment and care.
Although the SNP manifesto does not offer comprehensive, detailed plans for health – for the simple reason that these would not be relevant to a Westminster election – it does pose important and complex questions about how health funding should be determined within the UK, and who gets to make decisions about the NHS.
The Conversation’s Manifesto Check deploys academic expertise to scrutinise the parties’ plans.