Election 2015 Scotland

Election 2015 explainer: What can MPs do about NHS Scotland?

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The health service is a big issue for voters in the election. It's not by coincidence that the party campaigners want to talk about their commitment to it. But as health is devolved to Holyrood, where £4 in every £10 is spent on it, how much difference can this election make?

So, why does Scotland's NHS matter in this Westminster election?

NHS budgets

  • £12bn - Scotland's health service in 2015/2016

  • £115bn - England's health service in 2015/2016


Clearly, it's all about the money. The outcome of the Westminster election will help determine how much flows into the block grant coming to Holyrood. And how that money gets spent is up to MSPs - though it hasn't stopped that part of next year's election campaign invading this one.

Over the past five years, NHS spending has been protected by the coalition government. While all departmental spending has fallen 13% in real terms, the amount spent on health has risen 4%.

That feeds into the calculation, via the Barnett Formula, of the block grant. Once the health department budget is set in Whitehall, the Scottish block grant has a proportion of that added. That proportion changes slightly over time because Scotland's population gradually changes relative to England.

The UK government said that it added £1.3bn to the Scottish block grant as a consequence of decisions made for health in Whitehall over five years. That's a cash increase, not taking account of inflation.

This year's budget for NHS Scotland is just over £12bn, plus around half a billion for capital expenditure. In England, it's up to £115bn.

The Institute for Fiscal Studies says the real amount spent on the NHS in Scotland has fallen in real terms up to last year, by 1%. That still leaves spending per head in Scotland more than £1,000 ahead of England.

(The IFS has taken a look at the most recent numbers up to 2015-16, and found that they probably, on the data available, put Scottish spending into positive territory. That is, between 2009-10 and the current financial year, English health spending rose by 6% in real terms, while Scottish health spending rose by roughly 1%.)

So how much does Scotland's health service need?

The simple answer: more.

There are big pressures to increase spending. Many more people turn to the health service, with rising expectations of what it can do for them.

Health technology, treatments, procedures and medicines develop. And unlike other industries, the more you invest in innovation, the more expensive health care becomes.

That's linked to an ageing society. It's not just we're being kept alive longer by more advanced medical interventions than in previous generations: it's also that people's conditions are more likely to be chronic than they were. And that puts more pressure on both health and care services.

For these reasons, the inflation rate for healthcare is reckoned to be significantly higher than other inflation, at about 4% per year. But the money available to the NHS is nowhere close to matching that pressure.

There are calls for more family doctors, action to reduce waiting times in Accident and Emergency and money to tackle bed blocking. There's always pressure for more funding, but a lack of a big picture about the future needs of NHS Scotland.

What the politicians saying?

Simon Stevens, the head of the NHS in England, wrote a report which is having an unusually powerful impact on this election campaign. He said the health service in England needs £30bn more by 2020, on top of inflationary increases.

He concedes that better management, new ways of working and efficiency measures could find £22bn of that, leaving an £8bn gap.

That £8bn is being offered to the electorate by the Conservative Party, though it has not said how it could be funded, and it doesn't look likely until the last year or two of the next parliament. Scotland could assume that it would get £800m, says the Tory manifesto.

Lib Dems are pledging the same numbers, though they're planning to raise taxes, which would mean they can afford at least £1bn extra in the next three years.

The SNP has offered two sets of numbers. The £24bn increase by 2019-20 includes inflation, as does the £2bn of it that would come to Scotland.

Without inflation, it looks very like the Tory and Lib Dem plan - £9.5bn, of which about £800m would be Holyrood's.

Labour was first to set out its plans, and it bid low, at £2.5bn. It has detailed the tax increases that would pay for this, including an extra tax on high value properties, a 50% tax band for those earning over £150,000 and a banker bonus tax. About £200m would come to Scotland.

Labour then makes the link to more doctors and nurses. Indeed, they all do, as that is deemed to be the way the public understands health service funding.

How will any extra money be spent in Scotland?

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But while the election campaign in England concerns pledges of longer hours of doctor availability, more midwives, debate about the way the NHS is structured, and so on, none of these decisions for Scotland will be made by MPs.

They'll be made, instead, by MSPs. And two big questions arise for parties as they start setting out their stalls for the May 2016 Holyrood election.

One is how they intend to achieve the equivalent of that £22bn of health service reforms that Simon Stevens has set out for England. New ways of working, including hospital centralisation, are politically difficult.

Could taxes rise in Scotland to pay for the NHS?

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A large portion of income tax in Scotland will be raised by the Scottish Parliament from next spring, with more tax powers expected to follow later.

So the party manifesto writers will have to say how they intend to use Holyrood's tax-raising portion.

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