“I predict Scotland’s NHS will not last until it is 100 years old.” The chair of BMA Scotland, Dr Iain Kennedy, has again called for a national conversation on the future of the NHS, urging the Health Secretary to launch this initiative. This is clearly urgent and important, and the general public, as users of the service, must be involved. However, it seems equally important to consider who should sponsor such a conversation and how it should be conducted.


Rather than being established by the Government, there is a strong argument that what is really needed is a wholly independent review. This would free the party of government and other interested parties to present their ideas, including the commitment by the Health Secretary to continue access to free health care, while keeping all options open for discussion.


Given the seriousness of the situation – and that overall governance is a key issue – it seems imperative that discussion about the future does not close off any potential ways forward before all the possibilities and their implications have been fully and impartially explored. For example, consideration could be given to whether some users should pay for some services so that others who are less well-off can have access to what they need.


Scotland has recent experience of two Citizens Assemblies, the first on the topic of the kind of country we are seeking to build and the second on climate change. The first made a number of specific recommendations regarding the NHS and health care. These would be a good place from which to start any proposed national conversation. Indeed, the Citizens Assembly model would seem to be an ideal vehicle to take this forward. The concept of a cross-section of the country’s population taking an in-depth look at the issues, informed by contributions from experts in the field, deserves to be taken further.


Perhaps the Scottish Parliament could sponsor the conversation or perhaps the principal stakeholders could work together to form a steering group to act as stewards for the project. There is already considerable expertise and research available to draw on, covering not only the Scottish experience but other similar initiatives around the world.  It would be essential that the project is properly resourced, to encourage production of proposals which would be taken seriously. Funding could be sought from non-aligned trusts and philanthropists.


Timing is critical. There is no need to re-invent the wheel. Much information is already available and could be gathered speedily. An urgent approach should be adopted, unburdened by the kind of delays which seem to afflict public inquiries and endless consultations. It would be essential to report before the next Holyrood election, to provide an incoming government with recommendations on which to act.


John Sturrock, The Times, Friday 8 December 2003



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