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The Guardian - UK
The Guardian - UK
Politics
Michael White

Prescription for trouble

Scotland is a bit like France, a cherished near-neighbour with whom the English share so much, including mixed feelings about each other.

So it grieves me when I see the Scots marching up a cul-de-sac as they are doing this morning with that cut in NHS prescription charge rates, a down-payment on the road to their abolition.

Yes, I know the Welsh assembly and government have already done it. Both devolved governments have varying health policies, as Northern Ireland's will too as it gradually settles into normality.

Some will be better, including the availability of some drugs not available in England. Excellent. We can all learn from sensible experiments. But free scrips is not one of them.

Leaving aside the delicate matter of the Barnett formula, which has funded higher public spending per head in the Celtic regions for 30 years (Lord Joel Barnett himself is actively campaigning for a reform of his own formula and Gordon Brown has a review in hand), it's bad health policy, whether in Scotland, Slovenia or Surinam.

Why so? Because health takes an ever-larger share of GNP as countries get wealthier and individual citizens also spend more.

The policy is a huge success: we are, most of us, living longer than ever before and in better health. But the trend will only be affordable if we look after ourselves better - preventive healthcare - and pay more, whether via taxes or what are known as co-payments.

It doesn't matter what sort of healthcare system you adopt, the problem is the same, though I was pleased to see praise for the NHS's A&E services at St Thomas's hospital in central London from FT pundit, Philip Stephens yesterday.

He had a heart scare after a frustrating day at the new Terminal 5. At least Tommy's A&E works and is staffed by people who care, he noted.

Prescription charges are a form of co-payment for the adult, healthy, working minority who pay them. It raises the NHS in England about £400m a year (from memory), and the probably saves more by suppressing some forms of demand, as it is rightly intended to. Kids, the elderly (including me), and the poor don't pay.

But £400m is worth having. It will cost Scotland an estimated £57m a year to abolish charges for everyone - probably more if the soaring cost of another daft health policy (this one Lib-Lab, not SNP), free personal care, is any guide.

Projected costs are scary. Meanwhile, Scottish health outcomes, chiefly the result of lifestyle issues, not the industrial inheritance, nowadays, are still rubbishy by UK, let alone, EU standards. Ditto Wales.

So there is lots for Alex Salmond and his health minister, Nicola Sturgeon, to do without subsidising yet more activities of the Scottish middle class, which already does quite well out of public sector employment. As English scrips rise to £7.10 Scotland's drop to £5.

If I were a cynic - and I try not to be - I might say that the real pay-off for Alex is not a healthier middle class (lay off the booze, Jimmy), but headlines like today's in the Daily Mail which talk of ''Prescription Apartheid Day'' arriving.

Mr Salmond knows he can't get Scottish independence from the Scots alone. He needs equally short-sighted and disaffected English voters to go along with his plans. Crafty fellow.

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