13 June 2009

Devolution and healthcare

Dr Grumble has always been suspicious of devolution. Why did our political masters in Westminster want devolved government for Scotland and Wales? Was it just to keep the Celts happy? Or was there a more sinister motive? You could be forgiven for assuming it was the former. But why did Westminster want to give up powers to the English regions when there was no clear demand or need for local assemblies? It didn't make sense to naive Dr Grumble at the time but it does now.

In its wisdom the government chose the North East for a referendum on a local assembly because they thought it the region most likely to approve the proposal. But the electorate in the North East, unblinded by any sense of nationalism, shared the Grumble suspicion and wisely voted against a regional assembly. Not, of course, that this was going to stop the government. Oh no.

For Scotland it was different. Many there had long wanted devolution or separation and many others must have felt stirred by feelings of nationhood and nationalism and general grouses about the English. The Welsh, though initially more sceptical, went the same way.

Dr Grumble never saw much for England in all of this. Hiving off chunks of government to Scotland and Wales would surely make the UK weaker on the world and European stage. That seemed bad for all. And there was the bizarre West Lothian issue which means that Scots can exert decisive influences on the government of England. Quite mad really. Not that the English seem to mind very much. The West Lothian question was asked by a Scot not an Englishman. And the English do not seem to be much bothered by the rule of a Scottish prime minister. Well they might be bothered by his rule but it is the nature of his rule and not his Scottishness that is the issue. And in that they may have a lot in common with the Scots.

This is how others describe the regionalisation sleight of hand:

Unelected regional assemblies were set up in the late 1990s as part of the government’s adherence to the agenda of the European Union to break up the power of national Parliaments. England was divided into nine regions, including London. The intention was for each of these unelected assemblies to become elected - and for England to be governed by nine regional Parliaments, each – like the London Assembly - being given powers currently held by Westminster. The plan always was to take some of the powers of national Parliaments up to the various European institutions and others down to a more local level, thus leaving national Parliaments with little to do, hastening calls for their demise. Very few are aware that the official title of the European Union is ‘The European Union of the Regions’ - not of the nations. Source.

What does the devolution of Scotland and Wales mean for England? One advantage for the hapless and disenfranchised English is that it does at least mean that the questionable policies emanating from Westminster are being challenged. Nationalism and distance from the malign influences of the policy wonks and self-interested profiteers of the south allow those in the devolved nations to question the Westminster's health management mantras and show that, yes, there is another way.

The potential importance of devolution in the development of healthcare policy was brought home to Dr Grumble when he read the response from the Centre for International Public Health Policy to the Scottish government's consultation on the European Commission's proposals on cross-border healthcare. Since we don't have an English government the consultation process for England was not focussed on England but UK-wide. Many found the proposal confusing and the response to the consultation was mostly shallow. But in Scotland things are different. There they question things.

If you have no idea what Dr Grumble is rambling on about have a look at what Julie McAnulty has to say on the topic of cross border care. She explains it all rather well. She doesn't actually mention Scotland and she even refers to Brits. These are issues that face the UK as a whole. But if you look at Allyson Pollock's critique (pdf) you will see that devolution may allow a Scottish response to this which will be denied to the English.

Would you believe that Dr Grumble was once a staunch euro-enthusiast? We all make mistakes. Dr Grumble failed to spot that the EU was heralding the post-democratic era. That has to be bad. Could it be why the public are now so very disillusioned with politicians? If you vote you want to vote for change not a new group of managers with the same policies as the other lot. That is the nub of the problem


subrosa said...

Tony Blair was forced into offering devolution to Scotland as you say. The Scots don't have any gripe with the English but with what they see as an English government, ruling from over 500 miles away.

Thankfully our health care is in good hands at present and improving now we have someone who has her finger on the pulse.

All part of having a party in government who have our interests at heart and not those of the EU.

James Higham said...

And the English do not seem to be much bothered by the rule of a Scottish prime minister. Well they might be bothered by his rule but it is the nature of his rule and not his Scottishness that is the issue.


Julie McAnulty said...


Devolution really started to get going in 1985 when Scotland had a rates re-valuation and England didn't. It was actually a legal requirement; under Scots law, there had to be a rates revaluation every five years. It just so happened that over those five years the value of property had absolutely shot up. The result was a whole lot of Scots businesses went bankrupt and other big names were dealt major blows that led to their demise; Lewis's in Glasgow had their rates even higher than Harrods at that point and it finished them off. Anyway, in England, there hadn't been a revaluation for 12 years and the government didn't fancy having one, so instead they brought in the poll tax, with fixed rates and a cap. But they brought it in in Scotland first to test it out and it was an administrative nightmare. Because it was a poll tax and people move around, local authorities suddenly found themselves trying to keep track of people as they moved around. In Strathclyde there were 44 000 corrections a month to the register. The Inland Revenue are equipped for this; but your bog standard council wasn't and the whole shambles hardened the attitude of the Scots to Westminster.

Anyway, what would make the most difference to Westminster? I think PR would do it. Things move much faster up here under PR; everything is much slower down in Westminster and we have been able to take a different position from England on healthcare. It's also meant we can learn from your bad experiences; the carry on with private companies taking over GP practices and polyclinices means that groups like mine are keeping a very close eye for the same thing happening here, and at the mo the legislation that allows them do to that is being looked at with a view to tightening it up.

James- if it's any comfort, most Scots don't like Gordon Brown either. Remember, we didn't elect him either- his party did.

Oops- my word verification is 'inglis'. That's Old Scots for 'English'. Someone having a joke..

Dr Grumble said...

My word verification is 'inglis'
Now what are the chances of that?

Thanks for that detail, Julie. I had forgotten that the poll tax was tested in Scotland. But why wasn't that a learning experience for those down south?

I do remember devolution being encouraged from south of the border so do wonder if there was another agenda.

tally said...

The poll tax was never an experiment on Scotland. If on seeing it was a cock up in Scotland, they had decided to abandon the poll tax before it got to England then you could say it was an experiment on Scotland.
Rifkind in the press a few years ago apologised to Scotland for the poll tax,we never got one in England. Rifkind claimed that the poll tax in England was held up on technicalities, and that the Scottish tories saw no reason for Scotland to wait for England. This was a Scottish tory decision and Thatcher had to be persuaded to let it go ahead.Never the less the dustman from Durham was treated like longshanks when he ventured over the border.
Tony Blair was against devolution,it was Brown who pulled the trigger.
Subrosa,I'm a member of the Campaign English Parliament,there is no English government and the term "English MP's" is not correct.
They are firmly british. They see themselves as a party elected by constituents to represent them at Westminster, England does not come in to it.If you look at any of the three main party websites yoo will not see the word England.

Julie McAnulty said...

The fact that Westminster paid absolutely no attention to the problems that the poll tax had created and went ahead and implemented it in England, really illustrates the problem we had (and still have) of making our voice heard, tally. We were at odds ideologically with the government of the time, but could not express it; a problem you yourselves have when Scottish MPs vote on English legislation to push through the government line. We solved it partially with devolution and that has enabled us to take a different line on healthcare which might just save the NHS. Wales has done the same and it stopped approving PFI projects in 2004 as a waste of money. Personally I think that PR would be a bigger change to Westminster than simply designating it an English Parliament; PR keeps politicians on their toes because noone has an overall majority and opposition MSPs actually have to take responsibility for the decisions taken. They cannot oppose or propose things for the sake of it, because they have a stake in it. It makes for more responsible government.

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