Patients likely to lose out in independent Scotland

If Scotland achieves independence from the UK, patients north of the border requiring specialist surgery elsewhere in the UK could have to go through the same process as if they were travelling to a European Union state, leading, some argue, to delays in treatment and medical costs having to be paid by the patient.

The debate over Scotland’s constitutional future has taken on a new dimension.

A guest piece over the weekend in Scotland on Sunday raised fears about the ability of Scottish patients to access highly specialist procedures available only elsewhere in the UK.

Writing for the paper, 26 year old Sally Russell from Inverness wrote movingly about her battle with cystic fibrosis, which led, following a lung collapse, to her requiring a highly complex double lung transplant.

Outlining how the Freeman Hospital in Newcastle was her best option for a successful operation, she explained:

“The Freeman Hospital in Newcastle is pretty much one of the best places in the world for lung transplants. My consultant in Glasgow told me that when my time for a transplant came, the operation would take place at the Freeman’s as it was the best – and also there was nowhere in Scotland that could do it.”

Praising the staff at the hospital who enabled her to undergo a successful procedure, she continued:

“My transplant took place on 11 August, 2011. The surgeon who operated on me in Newcastle was Mr Pillay. He gave me new lungs. He has given three other young women from Glasgow like myself new lungs. He gave all of us a chance of living, he gave all of us a new life. Every day that I spend with my husband, my family and my friends I owe to my donor, his or her family, and the team in Newcastle.”

Concluding that she felt her story needed to be part of the debate over whether Scotland should become an independent nation she argued:

“What we have now is the ideal situation. We have an NHS in Scotland that is delivering world-class treatment to thousands of people across the country. But we also have specialist centres like the one I attended. The Freeman in Newcastle is the dedicated lung transplant centre for Scotland, Northern Ireland and the north of England. It would, of course, be possible to set up a transplant centre in Scotland, but it would not be possible to replicate the expertise developed through the large number of transplants performed over decades.

“The team in Newcastle don’t do transplants occasionally, it is their day job, they are ­doing them every week. Specialist­ centres – like Freeman’s in Newcastle – are available to everyone, whether you are from Scotland, England, Wales or Northern Ireland.

“I don’t want to have to rely on cross-Border agreements to get the care that I need. I don’t want the people who are sitting on the transplant list right now to have to worry about anything other than getting the treatment that will give them back their lives.”

Russell’s concerns have been seized upon by the Better Together, which has argued  that patients north of the border requiring specialist surgery elsewhere in the UK would have to go through the same process as if they were travelling to a European Union state, leading, the campaign argues, to delays in treatment and medical costs having to be paid by the patient before being reimbursed.

Scotland on Sunday went on to explain:

“Health boards in Scotland can at present arrange travel to specialist transplant centres such as Freeman Hospital in Newcastle or Papworth Hospital in Cambridge and there are few, if any, costs for patients. However, if Scotland votes to leave the UK in the 2014 referendum, patients seeking treatment in England, Wales or Northern Ireland would have to use one of two complex routes agreed between EU member states. Those healthcare arrangements are rarely used because of the complexity.”

Outlining her concerns about the impact independence would have on the level of healthcare available to Scots, shadow health secretary, Labour’s Jackie Baillie, observed:

It doesn’t matter if you are from England, Wales, Northern Ireland or Scotland – you can now go to any part of the country to get the care that your condition requires. You don’t need to worry about anything, other than getting the treatment you need.

“If we leave the UK, all of this will change. We would be replacing a simple, internal relationship with an international, cross-Border one.”

Echoing Baillie’s concerns, Margaret Watt, chairwoman of the Scotland Patients Association, noted:

“Whatever the outcome of the referendum, there is already pressure on patients when it comes to travelling for medical treatment and the system for treatment south of the Border is complicated enough. We wouldn’t want to see patients placed with any additional burdens.”

Scotland’s health secretary, Alex Neil, however, argued that an independent Scotland would retain existing arrangements with specialist centres elsewhere in the UK.

Assessing the political implications of Sally Russell’s contribution to the debate, Scotland on Sunday’s editorial observed:

“The political issue is that it demonstrates the administrative reality of Scotland and England being – in an official sense at least – foreign countries to each other, in the same way that the UK is to, say, Belgium at the moment. It is a strong campaigning suit for Better Together because they know that the harder the SNP and Yes Scotland work to spell out how these barriers could be worked around, the more they draw attention to the barriers themselves.

“Privately, some Nationalists are dismissive of the kind of campaigning that looks in granular detail at the administrative details of how an independent Scotland would work. When the NHS was created, they argue, did we worry about the number of bedpans that would be required? Or did we simply back the principle and get on with delivering it, and work out the detail as we went along? And they are right – for a committed supporter of independence, these are mere details. The problem is that the people the Yes campaign needs to persuade are not committed supporters, and the kind of details raised by Sally Russell are the kind that make them pause.”

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