ANALYSIS

The vote against independence for Scotland is just the beginning of what looks set to be a long process of change throughout the UK, says Katie Osborne

Debate on English devolution could have repercussions on health policy Few could have predicted that the Scottish referendum result last month would have sparked such intense debate and speculation on the subject of devolution in England. But within hours of the vote against independence for Scotland, prime minister David Cameron announced proposals to introduce English votes for English laws (EVEL). Since the devolution of powers over health, education, the environment, and law and order to Scotland in the late 1990s, English MPs have been unable to vote on those issues. But Scottish MPs in Westminster can still vote on matters that affect England only.

Powers for England

Mr Cameron argues that if Scotland is to get ‘extensive new powers’ on tax and welfare, promised by all three main political parties at Westminster in return for a ‘no’ vote in the referendum, England should benefit too. Such a move could, however, have significant repercussions for health policy in England. Withdrawing the right of 41 Scottish Labour MPs to vote on issues affecting England could mean that if Labour wins next year’s general election it could struggle to win enough support to pass into law its manifesto pledges in areas such as the NHS in England. In effect, there could be a situation whereby the country has a national Labour government whose English policy is controlled by the Conservatives in coalition with the Liberal Democrats.

This casts doubts on whether pledges on the NHS, which include integrating the health service with social care, made by shadow health secretary Andy Burnham at the Labour party conference in Manchester last week, would be made a reality. RCN Scotland board member Geoff Earl argues that if English MPs do not want Scottish MPs voting on English matters, the English system should be devolved. He holds that the UK parliament is just that, a UK parliament that represents the entire UK. He stresses that decisions made about the NHS in England affect the health service in Scotland. Wider issues

IT COULD MEAN MORE AUTONOMY FOR GOVERNMENTS – Howard Catton

being negotiated by the government at a European level, in particular the Transatlantic Trade and Investment Partnership (TTIP), are also a concern. The TTIP aims to open up trade between countries in the European Union and the United States in goods and services. The RCN is lobbying the government to exclude the NHS from the TTIP, arguing that it would lead to a cut in pay for nurses, less favourable terms and conditions, and increased privatisation of the health service. ‘If Scottish MPs are barred from voting on TTIP, the Conservative government will introduce it,’ he warns.

‘This means the Scottish Government, which has not gone down the privatisation route with the NHS, would lose that control.’ RCN head of policy Howard Catton acknowledges there are concerns that stopping MPs from Scotland, and further down the line Wales and Northern Ireland, voting on devolved issues such as health care, could pave the way to further privatisation of the NHS in England.

Two sides of the coin

‘I recognise the concerns that people might have that MPs who are sympathetic to the private sector will be making decisions on health policy,’ he says. ‘But it could also mean more autonomy for local governments to develop health services and this has to be supported.’ A spokesperson for the Conservatives defends the government’s commitment to the NHS: ‘The Conservative Party has prioritised the NHS in England while taking difficult decisions elsewhere – investing £12.7 billion in healthcare during the course of this parliament, as well as having the highest number of nurses, health visitors and midwives in the history of the NHS.’ But an analysis of workforce figures by the RCN shows that, while there are 3,289 more full-time equivalent nurses midwives and health visitors compared with May 2010 overall, the boost in numbers has been in midwives and health visitors. There are 329 fewer nurses. A joint survey of almost 6,000 nurses by Nursing Standard and the

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ANALYSIS

David Cameron proposes to introduce English votes for English laws

Sunday Mirror, published last month, also revealed that our readers view the government’s track record over the past four years on the NHS rather more bleakly. More than half of nurses who responded to the survey – 55 per cent – said the standard of care patients receive has fallen since Mr Cameron became prime minister in 2010. Half told us there were not enough staff on their last shift to provide a safe level of care. Health secretary Jeremy Hunt’s decision in March to reject the independent NHS Pay Review Body recommendation of a 1 per cent pay rise for all nurses has provoked anger among nurses. Nurses across England who are members of the unions Unison, Unite and the Royal College of Midwives will go on strike on October 13 in protest at the unfair pay deal. Grant Bryne is a third-year nursing student at the University of Glasgow.

He thinks EVEL would be a positive move and understands why English MPs become frustrated by Scottish involvement in English matters. But he fears that unless a separate English parliament, which gives England an identity away from Westminster, is established, a two-tier parliamentary system could emerge at Westminster.

Student perspective

He says: ‘The biggest impact could be on public health as all four nations will have very similar issues to deal with but very different ways of delivering services. In Scotland there is extremely strong support for the NHS, whereas England is going down the privatisation route. ‘So while EVEL poses a risk to the Scottish NHS it is not nearly as much as the referendum did. There is nothing to say that future devolved governments would not be able to opt out of decisions anyway.

‘The positive aspect of this is that we are seeing a move towards a more federal UK, which is a good thing. But, it is all so new at the moment, we should wait and see.’ The issue of EVEL was first raised in the 1970s by West Lothian MP Tam Dalyell during debates in the House of Commons on Scottish and Welsh devolution and has since become known as the West Lothian question. Mr Cameron has been vague about the specific details of his proposals, but it is understood a committee of senior Conservative MPs met last week and agreed to it in principle. Leader of the House of Commons William Hague has been appointed to lead a committee that will draw up proposals on how such a system might work by January 2015. Mr Cameron has indicated that the principle will also apply to Welsh and Northern Irish MPs in the future NS

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Debate on English devolution could have repercussions on health policy.

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