Lansley opens the door to full-scale NHS privatisation (Updated: no, he doesn't)

The 49% cap on private work done by NHS trusts will be abolished.

Update 2: Just to clarify, this piece was based on a Financial Times story, which the Department of Health has told us is incorrect. The FT has silently changed the headline, standfirst and content of its story. However, we have decided to leave this piece online, with the relevant correction.

Update: The Department of Health has been in touch to say that the cap is not being removed, rather that the planned 49% limit will be introduced from 1 October 2012.

The spokesman added: "Services for NHS patients will still be protected as the Health and Social Care Act 2012 sets out that foundation trusts still have a core legal duty to provide services to them.  The majority of their income must also come from NHS sources.  Income from non-NHS sources will also be reinvested back into wider hospital services, to benefit NHS patients."

When the government unveils a policy change on a Friday it's a sure sign that it doesn't want you to notice. Today, Andrew Lansley will announce that the 49% cap on private work done by NHS hospitals, which his bill introduced, will be abolished. In other words, the Health Secretary has just opened the door to the full-scale privatisation of the NHS, with hospitals able to raise 100% of their income from private healthcare.

Sue Slipman, the chief executive of the NHS Foundation Trust Network, describes the removal of the cap as "a really creative way of bringing more money into the health service". What she doesn't say is that foundation trusts, in pursuit of profit, will likely prioritise the treatment and care of private patients over NHS ones. Since the most profitable procedures are usually the simplest, those requiring more complex treatment will be pushed to the back of the queue. As Howard Catton, head policy at the Royal College of Nursing, has previously warned: "NHS patients may feel a subtle pressure to reach for the credit card." Since all of the remaining 113 NHS trusts are required to become self-governing foundation trusts by April 2014, the removal of the cap will apply to all NHS services - hospitals, ambulances, mental health, community services and clinics.

What makes this change so unexpected is that Lansley's original plan to place no ceiling on private treatment was rejected under trade union and Liberal Democrat pressure. There are two possible explanations: either the Lib Dems signed off on the policy or they weren't told. Either is disastrous for their credibility.

Health Secretary Andrew Lansley plans to allow NHS trusts to raise 100% of their income from private treatments. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

Getty
Show Hide image

Winning Scottish independence will be even harder than before - but it may be the only choice

Independence campaigners will have to find answers on borders, currency and more. 

The Brexit mutiny has taken not just the UK economy and its relationship with Europe into uncharted waters. it has also imperilled the union between Scotland and England. From Sir John Major to the First Minister, both Unionists and Nationalists had warned of it. The outcome, though, has made this certain. The Leave vote in England and Wales contrasted with an overwhelming Remain vote north of the border.

That every region in Scotland voted to stay In was quite remarkable. Historically, fishing and industrial communities have blamed the European Union for their woes. That antagonism was probably reflected in lower turnout - an abstention rather than a rejection. 

The talk now is of a second referendum on independence. This is understandable given the current mood. Opinion polls in the Sunday Times and Sunday Post showed a Yes vote now at 52 per cent and 59 per cent respectively. Moreover, anecdotal evidence suggests even arch No vote campaigners, from JK Rowling to the Daily Record, are considering the option.

The First Minister was therefore correct to say that a second referendum is now “back on the table”. Her core supporters expects no less. However, as with the economy and Europe, the constitutional relationship between Scotland and England is now in uncharted seas. Potential support for independence may be higher, but the challenges are arguably bigger than before. The difficulties are practical, political and geographic.

Of course the Little Englanders likely to take the helm may choose a velvet divorce. However, given their desire for the return of the Glories of Britannia that’s improbable. They’re as likely to wish to see Caledonia depart, as cede Gibraltar to Spain, even though that territory voted even more overwhelmingly In.

Ticking the legal boxes

Practically, there’s the obstacle of obtaining a legal and binding referendum. The past vote was based on the Edinburgh Agreement and legislation in Westminster and Holyrood. The First Minister has indicated the democratic arguments of the rights of the Scots. However, that’s unlikely to hold much sway. A right-wing centralist Spanish government has been willing to face down demands for autonomy in Catalonia. Would the newly-emboldened Great Britain be any different?

There are no doubt ways in which democratic public support can be sought. The Scottish Government may win backing in Holyrood from the Greens. However, consent for such action would need to be obtained from the Presiding Officer and the Lord Advocate, both of whom have a key role in legislation. These office holders have changed since the first referendum, where they were both more sympathetic and the legal basis clearer. 

Getting the EU on side

The political hurdles are, also, greater this time than before. Previously the arguments were over how and when Scotland could join the EU, although all accepted ultimately she could remain or become a member. This time the demand is that Scotland should remain and the rest of the UK can depart. But will that be possible? The political earthquake that erupted south of the Border has set tectonic plates shifting, not just in the British isles but across the European continent. The fear that a Brexit would empower dark forces in the EU may come to pass. Will the EU that the UK is about to leave be there for an independent Scotland to join? We cannot know, whatever European Commission President Jean-Claude Juncker may be saying at the moment. The First Minister is right to start engaging with Europe directly. But events such as elections in France and the Netherlands are outwith her control. 

Moreover, currency was the Achilles heel in the last referendum, and hasn’t yet been addressed. George Osborne was adamant in his rejection of a currency union. The options this time round, whether a separate Scottish currency or joining the euro, have yet to be properly explored. A worsened financial situation in the 27 remaining EU members hampers the latter and the former remains politically problematic. 

The problem of borders

Geography is also an obstacle  that will be even harder to address now than before. Scotland can change its constitution, but it cannot alter its location on a shared island. In 2014, the independence argument was simply about changing the political union. Other unions, whether monarchy or social, would remain untouched. The island would remain seamless, without border posts. An independent Scotland, whether in or out of the EU, would almost certainly have to face these issues. That is a significant change from before, and the effect on public opinion unknown.

The risk that's worth it

Ultimately, the bar for a Yes vote may be higher, but the Scots may still be prepared to jump it. As with Ireland in 1920, facing any risk may be better than remaining in the British realm. Boris Johnson as Prime Minister would certainly encourage that. 

David Cameron's lack of sensitivity after the independence referendum fuelled the Scottish National Party surge. But perhaps this time, the new Government will be magnanimous towards Scotland and move to federalism. The Nordic Union offers an example to be explored. Left-wing commentators have called for a progressive alliance to remove the Tories and offer a multi-option referendum on Scotland’s constitution. But that is dependent on SNP and Labour being prepared to work together, and win the debate in England and Wales.

So, Indy Ref The Sequel is on the table. It won’t be the same as the first, and it will be more challenging. But, if there is no plausible alternative, Scots may consider it the only option.

Kenny MacAskill served as a Scottish National MSP between 2007 and 2016, and as Cabinet Secretary for Justice between 2007 and 2014.