Labour are asking fundamental questions about the affordability of healthcare in Scotland

Busy with England’s NHS reform dramas, how much do you follow health politics in Scotland, which are very different in some ways, deeply familiar in others? “Not enough,” I’d say. But the party conference season and Alex Salmond’s referendum deal on independence with David Cameron was enough to command attention.

In fact, Labour’s new leader in Scotland, Johann Lamont, had already raised the temperature in Edinburgh. She accused the SNP administration at Holyrood of kicking “fundamental questions” about the affordability of Scotland’s public services into the long grass while campaigning for independence in a world becoming tougher by the day as Asia reasserts its economic power.

‘What Alex Salmond calls “progressive” politics of the future, his critics call unrealistic bribes to middle class voters’

Remember, all Scots get free prescriptions, and have no tuition fees or social charges for the care of older people. What Mr Salmond calls “progressive” politics of the future, his critics call unrealistic bribes to middle class voters, funded by the 1970s Barnett Formula, which gives more per capita to Scottish patients. Labour Wales, which has less generous terms, has already cut health funding but kept free prescriptions. Scotland can’t afford it, ex-auditor general Robert Black, warned fellow Scots last month.

The wider political context was provided by Mitt Romney, no less, when he argued that 47 per cent of Americans (Democrats) live off the state by taking more in benefits than they pay in taxes. The Thatcherite Centre for Policy Studies tried the same pitch here, claiming 53.4 per cent of Brits are net benefit recipients. Scottish Tories then claimed only 12 per cent of Scots are net contributors, 88 per cent are net takers - ie the rich pay more than their share.

Flawed logic

Such claims are basically flawed, for example the beneficiaries include pensioners and the taxes exclude VAT. But Lamont framed the fairness question another way: “What is progressive about a banker on more than £100,000 a year benefiting more from a council tax freeze than a customer on an average income? What’s progressive about a chief executive on more than £100,000 a year not paying for his prescriptions, while a pensioner needing care has their care help cut?”

It’s a good question, also being asked (sometimes ducked) in England. One example is The Guardian report that Andy Burnham was told to trim his pledges that local government would take over integrated health and social care commissioning if Labour takes power in 2015. They were made at fringe meetings during Labour’s Manchester conference but left out of his crowd-pleasing podium speech.

The Eds (Miliband and Balls) worried about cost implications, though localism is hard to square with “putting the N” back into NHS. Miliband was also booed at the TUC’s latest anti-cuts rally for warning that cuts are unavoidable. But he’s right, and polls say most voters know it despite their resentment. It’s all about credibility.

Back in Scotland, Lamont’s bid for credibility prompted a fierce counterblast from the Salmond camp. At the SNP conference last weekend in Perth, Alex Neil, who recently took over from Nicola Sturgeon as health minister, savaged her “something for nothing” critique and promised to keep all free care and ‘scripts.

Neil is seen as a leftwing bruiser, as scornful of the gradualist wing of the independence movement as he is of “illegal war” in Iraq. But even he had a familiar agenda for NHS Scotland: integration, a focus on the poorest and the drive for efficiency amid familiar successes (faster cancer treatments) and failures, like the row over the £320,000 payoff - plus £75,000 pension - for Professor James Barbour, ousted as chief executive of NHS Lothian in light of poor care. It was in his contract, protested Salmond. Sounds very English to me.

Michael White writes about politics for The Guardian