Here is a question - assuming Andrew Lansley's white paper on 'Liberating the NHS' becomes law, what financial muscle will the Scottish Parliament have that a foundation hospital in England doesn't?Answer - Potentially none. Certainly barely a sinew.
Indeed, there is a strong chance that the English & Welsh trusts will have more fiscal freedom than Holyrood. Current plans include allowing NHS trusts to earn unlimited income from outside the NHS. A Scottish Parliament equivalent would be setting its own taxes, something that is currently not allowed of course and will only extend to a fairly inflexible group of taxes once the Calman recommendations are imposed.
Another potential difference surrounds the question of what would happen if a foundation hospital runs a surplus (a point raised in this excellent Guardian interview with Shirley Williams). Were this money to be allowed to be carried over into the next term's budget, as would seem likely if Lansley is intent on 'freeing' these individual bodies, then the NHS would be afforded a financial flexibility that a lack of which has hamstrung Holyrood during its short lifetime.
After all, how can a Scottish Government be expected to manage the 'boom and bust' of a UK Government if it can't operate save for the future or build a working overdraft? Any Scottish Parliament underspend is sent back to UK Treasury resulting in a double whammy of spending on unnecessary projects to meet any given year's budget and not having reserves for when times are tough, for example now. Scotland had almost a £1bn underspend from 2002-04. What it could have done with that money today!
When the simple logic of a hospital raising its own funds, having the power to spend it where it sees fit and being allowed to keep any underspend does not apply to a Parliament under the remit of the same Government, something is not quite right.
This health white paper is entitled 'Liberating the NHS'. Perhaps the Scotland Bill should go further than the halfway house of Calman recommendations, suggest full fiscal autonomy and be called 'Liberating Scotland'?
You could say it's what the doctor ordered.
6 comments:
There is no such thing as a Welsh NHS trust anymore. They were abolished by the devolved administration. Please stop repeating the same mistake as the London-based BBC and lumping Wales in with England. In terms of the NHS, "England and Wales" ceased to exist in 1999.
try to get your facts correct. Not everything that exists in England has necessarily to exist in Wales. - There are no foundation hospitals in Wales only in England
Wow, tough crowd.
I thought I'd overreached with this one but not literally in terms of geography...
Post updated accordingly, thanks.
Forgive me saying so, but surely if it was of a mind to do so, the Scottish Government is able to give Scottish NHS Trusts exactly similar powers to those propsoed for England?
Foundation hospitals were voted in on the deciding votes of welsh and scottish mp's against the wishes of a majority of English mp's.
The student tuition fees saga also courtesy of welsh and scottish labour mp's. time for home rule for England.
You're correct Sandy but that's not the point I was trying to make.
My point was simply that of the two Treasury cost codes, one for Scotland's Parliament and one for England's NHS Trusts, you would think the Parliament would have more fiscal freedom but that doesn't seem to be the case.
Post a Comment