Forget independence. Forget devolution. There is no bigger issue in Scotland than health. It is often said that the NHS is a religion in England, but this is even more true in Scotland. In 2014, then-First Minister Alex Salmond significantly boosted support for independence thanks to his declaration that the NHS would be “privatised” if Scotland remained in the Union. Yet now the service is effectively being privatised by the Scottish National Party.

At least that was the assessment of the head of the Scottish BMA, Dr Iain Kennedy, during an address to the medical union’s national conference in Liverpool on Tuesday. Kennedy revealed research confirming what everyone suspected: that more and more Scots are being forced to go private rather than languish in pain on ever-lengthening waiting lists, which now account for more than one in 10 adults in the country.

According to a survey of 1,203 respondents by the Diffley Partnership, a third of Scots say they or someone else from their household have had to resort to private health in the past two years. What’s more, 17% had actually accessed private medical care and 14% said a member of their household had.

Kennedy claimed it is now “abundantly clear” that there is a two-tier service in Scotland, and that the divide represents creeping privatisation of the NHS north of the border. Except Scots are not so much creeping as voting with their feet, fast: the numbers going private have increased threefold in the last four years.

This represents not just elective queue-jumping, but also a radical change in attitudes to a service that is supposed to be free at the point of need. Confidence has been lost: 46% of Scots who do not use private healthcare now say they would go private if they could afford it. “The NHS is dying before our eyes,” Kennedy said on Tuesday.

How did we get here? Scotland used to have the best-financed and most highly regarded health service in the UK. Yet now nearly one in six Scots are waiting for treatment, according to Scottish Labour Deputy Leader Jackie Baillie, often in considerable pain and discomfort. Just getting a place on an NHS waiting list is difficult enough. Rather than wait years for elective surgery, people are being quietly advised by their GP to go private if they want early relief.

The SNP government invariably blames “Westminster austerity” for its failure to meet its own supposedly binding targets for care. But the Scottish government receives over £1,500 more spending per head than the overall UK figure, according to the latest Treasury figures. Money has never been the issue here.

Really, the NHS has deteriorated rapidly in the last decade, despite generous pay awards in Scotland to doctors and nurses who earn significantly more than their English counterparts. Since the pandemic, NHS productivity has declined, despite there being 13% more consultants and 12% more nurses than in England, according to the Institute for Fiscal Studies.

Then there is the crisis in social care, with up to one in 10 NHS beds occupied by an often elderly patient who should not be there. But the awkward truth is that the nationalists have been diverting finance from the NHS to fund their other social programmes. At the dawn of devolution, Scotland spent 22% more on health than England. By 2019, that had fallen to just 3%.

These figures demonstrate that the Westminster austerity claim simply does not wash. The SNP cannot blame anyone but itself for the collapse of trust in the NHS in Scotland. But this is electoral kryptonite for the nationalists. Their failure on health towers over their other shortcomings in education, public procurement and housing. It really is a matter of life and death, and behind the figures lies untold human suffering.

The SNP government cannot now avoid a reckoning in next year’s Scottish Parliament elections. Party support has been in steep decline, as evidenced by its loss of the previously safe seat of Hamilton, Larkhall and Stonehouse earlier this month. If, after nearly two decades in office, the nationalists are humiliated next year, it will be health — not separatism — that has put them there.

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Iain Macwhirter was political commentator for The Herald between 1999 and 2022. He is the author of Disunited Kingdom: How Westminster Won a Referendum But Lost Scotland.

iainmacwhirter

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