Did the LibDems just vote me towards independence?

A record-breaking 172,475 people have signed Dr Kailash Chand’s e-petition to drop the NHS Reforms bill.

David Cameron promised once upon a time that any e-petition that got more than 100,000 signatures would get a debate in the House of Commons, but he evidently meant “any e-petition that Tories can support without going against the interests of our donors“.

At the Liberal Democrat conference today:

2.21pm: Nick Clegg has won his first battle of the conference. According to Channel 4’s Michael Crick on Twitter, Lib Dem activists have chosen to debate the Shirley Williams health motion tomorrow – the pro-leadership one – instead of the rebel motion calling for it to be withdrawn or defeated.

2.27pm: The Shirley Williams health motion got 309 votes. The rebel “drop the bill” one got 280 votes.

On Tuesday 13th March, the e-petition will have a House of Commons debate and the House of Lords will have a 3rd-reading debate on the Bill.

If the Bill becomes law, while it will not apply to the NHS in Scotland (or in Wales) Scots travelling in England will have to reckon with the possibility they may not get emergency treatment on the NHS. This will apply to anyone travelling outside their region. I get this from reading Allyson Pollock, David Price, and Peter Roderick’s recently published article in the BMJ, Health and Social Care Bill 2011: a legal basis for charging and providing fewer health services to people in England. I may be wrong, but that’s certainly what it looks like.

The new clinical commissioning groups (CCG) are not required to provide the following services to people who happen to be in their area:

  • Accident and emergency services and ambulance services
  • Services provided at walk-in centres
  • Facilities and services for testing for, and preventing the spread of, genitourinary infections and diseases and for treating and caring for persons with such infections or diseases
  • Medical inspection and treatment of pupils
  • Services relating to contraception
  • Health promotion services
  • Services in connection with drug and alcohol misuse

The regulations requiring local NHS services to provide these to anyone will be repealed, and the NHS Reform bill does not require CCGs to secure any of the above services except ambulance and emergency care for residents of the area [update] people in the area defined in their constitutions:

The bill therefore establishes a legal basis for CCGs to secure fewer government funded health services. The bill also transfers from the secretary of state to CCGs the power to determine what is “appropriate as part of the health service” for certain individuals. The services concerned are care of pregnant and breastfeeding women, care of young children, prevention of illness, care of people with illnesses, and aftercare of people who have been ill.

[Update: Clause 12 of the bill (link goes to the version amended by the Lords in committee), we find:

(1C) The power conferred by subsection (1B)(b) must be exercised so as to provide that, in relation to the provision of services or facilities for emergency care, a clinical commissioning group has responsibility for every person present in its area.

Note - present not resident, so travellers would be covered for emergency care at an A&E, but aftercare or services defined as non-emergency... not.]

If you live in Scotland and visit England – especially while you are pregnant, breastfeeding, traveling with a child, if you had a serious illness and need aftercare – if for any reason you are suddenly ill in London or the West Midlands, or you suddenly need aftercare because you were ill – you may have to pay.

For most of us, the only time we buy private health insurance is when we’re going on holiday, as part of the travel insurance policy. When I’m travelling outside the UK in Europe, I carry my European Health Insurance Card (EHIC) – it’s free, and it means that effectively I’m carrying the NHS with me.

But you can’t use that card inside your own country. You can’t use travel insurance inside the UK.

We could only carry the unreformed NHS with us from Scotland if we voted for independence in autumn 2014, and travel to England became travel to a foreign country.

The Scottish National Party is holding their conference this weekend in Glasgow. I did not expect to hear any new arguments convincing me towards independence.

I certainly didn’t expect the vote that could decide me to vote Yes in Autumn 2014 to be a 29-vote majority at the Liberal Democrats conference in Newcastle Gateshead. And I find it immensely irritating, as a non-supporter of the SNP, a more-or-less devolution supporter and an admittedly-unenthusiastic unionist, that it’s the Westminster parties that are, one by one, convincing me to vote for independence.

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28 Comments

Filed under Elections, Epetitions, Healthcare

28 responses to “Did the LibDems just vote me towards independence?

  1. It’s not obvious, from the above, that *English* residents aren’t going to need medical insurance when travelling away from their own towns — even as far as the NHS trust next door. I would *expect* a sane system to include some sort of reciprocity arrangement for travellers, but this isn’t obviously being designed with sanity in mind …

    • Part of the problem is that whether or not the area you are travelling in does allow a reciprocity arrangement for travellers, will be completely up to the area CCG. Their policies ought of course to be transparent – but all it takes is a website not-updated or a web failure (or not realising that you’re traveling out of the area covered by one CCG into another)…

  2. Euan

    I’ll start by saying I’m pro-independence. Have been for a while. But I’ve always enjoyed healthy debates on the various issues that may-or-may-not change for the better/worse if Scotland were to leave the union. Since the con-dems took power in Westminster…. let’s just say it’s been increasingly more like this post – “Oh god, I don’t want independence on its own merits, but staying just looks hellish now”. The NHS reforms are undoubtedly the biggest mess they’ve made of things, though. I’m…gobsmacked at the whole thing. Tories will be Tories, I guess?

    • I’m really gobsmacked myself. I’d been feeling angry about the mess the Tory NHS reform was making of English NHS, and selfishly relieved that this wasn’t going to affect the NHS in Scotland. It hadn’t occurred to me that this will of course affect travel in England.

      • Geoff, England (not Britain or 'United' Kingdom)

        But there will be a knock-on effect on the NHS in Scotland, thanks to Barnett consequentials, if government spending on the NHS in England is reduced.

  3. Wee Red Squirrel

    Reblogged this on The Wee Red Squirrel and commented:
    Great post about why NHS reforms matter north of the border. It looks increasingly like independence is the only way to preserve our health service.

    • Or 51 LibDem MPs suddenly realising that they’re not getting even a Ministerial salary out of the coalition….

    • Geoff, England (not Britain or 'United' Kingdom)

      Another strong argument in favour of independence is the British government’s foreign policy, which seems to be one series of pointless, morally and legally suspect and crippingly expensive wars. Do you really want to be associated with that?

      • Wee Red Squirrel

        I’m wary of putting too much emphasis on foreign policy, as Brown, Darling, Reid etc were all complicit in Labour’s misdemeanors over the last decade.

        • I agree with that. True, I haven’t felt comfortable about voting Labour since Iraq. But the Conservatives were equally complicit, and the LibDems would, we now know, have supported either party about the invasion if they’d happened to be in coalition at the time. And yes: Scottish politicians were involved at every level. So it goes.

  4. Les Swanson

    So what happens if someone from the East Midlands visiting Scotland falls ill, will they still get free treatment or will we have to charge them?

    • Wow. I don’t know. Seriously. That’s a … good question.

    • Geoff, England (not Britain or 'United' KIngdom)

      Why does it have to be someone from the East Midlands? Why don’t you just say ‘England’? We’re all discriminated against by the Anglophobic racist Brits.

      • Les Swanson

        I never said East Midlands as a racist comment only because it was used in a previous post and I can assure you Geoff I am in no way a racist or even slightly anti-English but I do want independence from this arogant Westminster Government who runs this so called Union. They keep on telling us Scots that we are all equal together in this Union but they do this to your English NHS and please do not imply that I am some kinf of “BritNat” you couldnt be further from the truth!!

  5. Detective Chimp

    I just had a look at the consortia map there and these CCG are very small. It isn’t just a case of someone needing insurance if they leave “The East Midlands” they’d need it if they got the bus to the other side of Leicester!

  6. Looking at Clause 12 of the bill (link goes to the version amended by the Lords in committee), we find:

    (1C) The power conferred by subsection (1B)(b) must be exercised so as to provide that, in relation to the provision of services or facilities for emergency care, a clinical commissioning group has responsibility for every person present in its area.

    Note, that’s “present in”, not “resident in”. So AFAICT you’d still be seen in A&E if you were taken ill while visiting England. Aftercare would be a different matter, though.

    • Note, that’s “present in”, not “resident in”. So AFAICT you’d still be seen in A&E if you were taken ill while visiting England.

      Fair dos. Thanks for the link.

      Aftercare would be a different matter, though.

      As would non-emergency care – which can still be fairly essential, especially if you want to keep emergencies from not happening.

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  8. I posted this on Bellacaledonia

    IF Scotland takes its independence then the E111 card comes into play?

    I live in France and have a French E 111 which should cover me?

    This looks like a most frightful cockup but then it is the dogma driven Tories we are talking about.

    Mind you Labour supported them all the way.

    • Apparently CCGs are obliged to provide emergency services to everyone in their area, even if not resident, but not necessarily non-emergency care. So it will depend what constitutes emergency care.

      It is a bloody cockup. Labour laid the foundations for it to happen, but the Liberal Democrats and Conservatives have built the auction house.

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  11. Bill Miller

    I really don’t get the problem here. Emergency provision is made for everyone in the area of a CCG. Aftercare etc. is comissioned by your “home” CCG.

    No doubt there are some wrinkles to sort out but basically it’s simple, isn’t it?

    • Emergency provision is made for everyone in the area of a CCG. Aftercare etc. is comissioned by your “home” CCG.

      Everything’s simple providing you live & work in the same CCG area and you’re not in a complicated health situation and you don’t travel a lot and you’re not pregnant and you don’t have kids.

      Honestly, this whole dismantle-the-NHS thing the Tories are doing in England/Wales – it’s one of the very best reasons for voting Yes to independence.

  12. What you’re writing about here, EE, is the longform version of the argument that ultimately convinced me independence was the only way forward (admittedly quite a while ago, circa 2008). It is that there are many excellent arguments for staying in the Union, but that it is not in the interests of the people in charge of that Union to make them.

    In other words, the things I want Britain to become are directly contrary to the interests of the people Britain is beholden to, i.e. political donors, party appointees and The Square Mile. There is an argument made by the Hothersalls of this world that we should stay and fight this kind of naked profiteering at the expense of the sick (or disabled or unemployed or women or take your pick…) but that has to run into the realization that our weaponry to wage that war amount to rusty Claymores (the swords, not the land mines). Our opponents, meanwhile, have Trident missile submarines.

    For a lot of people, it will be a sad day (as I sense it is for you) when they realize that independence is the only chance to save some of the most fundamental aspects of the Britain they grew up in and came to love. But hopefully, like me, you’ll eventually feel liberated by that realization and energized by the opportunities independence will make available.

    An excellent post.

    • Didn’t realize the date on this…

      • Yep. I remain undecided. I’m definitely in agreement with the Hothersalls that it would be better if the whole of the UK reversed the things the Tories and LibDems are doing to British institutions.

        With some things, like welfare reform, Labour doesn’t give any confidence they intend to do that.

        With some things, like the NHS, it worries me that Labour might not be able to fix the changes.

        But I still think it would be better for there to be a UK-wide fix,

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