As I write this, I am on a flight from Heathrow back home to Edinburgh. Right after we land the pilot, in a Freudian moment, announces ‘Ladies and Gentlemen, welcome to England…err Edinburgh!’ Queue laughter from the passengers and silence from the flight deck before a second attempt corrected the mistake.
Whether or not you give credence to the nationalist view that, to the English, Scotland is simply an outcrop largely to be ignored or that by living in Edinburgh I have more shared identity with someone in Motherwell than someone in Manchester simply because we can both pronounce ‘loch’ correctly, is a matter for the national newspapers and perhaps not Optician magazine.
There are a number of things about independence we can’t possibly know in advance and, in many ways, whether you take an optimistic view on these issues or a cautious view may influence your final decision on the vote. But fortunately for this piece, health is one of those areas where there is no shroud of mystery as it has been in plain view since 1999 and therefore the debate as to whether or not optometry will gain by independence is quite easily settled: optometry in Scotland stands to gain precisely nothing by independence.
Since 1999 spending on health has been fully devolved and under the control of the Scottish government which has lead to an increasing divergence between Scottish and other UK optometry services under GOS. Free eye exams sat alongside other promises as a major plank of devolution which, to give credit to its architects, has achieved some impressive things for Scottish optometry. In fairness it was a perfect storm, the right people at our end speaking in unity to a receptive government at the other has produced success after success for Scottish optometry.
Professional progress
GOS in Scotland has tapped into the desire of optometry across the UK to be paid fairly to do a decent clinical job, with the vast majority of optometrists north and south eager to step up to the professional plate. A fair fee for NHS work, funds for independent prescribing work and repeat tests, enhanced clinical freedom and use of professional judgement have allowed optometry to progress nationally in a way that anyone who is engaged with their profession will be pleased to see.
Add to this the educational funding we receive through NHS Education for Scotland, fully funded IP training and placements, first-of-their-kind Teach and Treat training facilities popping up around the country, new MSc courses combining medical ophthalmology and optometry training for the first time and the introduction of FP10 prescribing pads as the culmination of many years of aspiration and effort – it’s a great time to be an optometrist in Scotland.
Now all this has been achieved under devolution and it is therefore impossible to argue that optometry in Scotland would be better off under independence as we’re already striding out into new frontiers as part of the UK. You might use this argument to say ‘Well if that’s what you did under devolution, then imagine what you can do under independence’ but health can be no more devolved than it currently is. As a wise old Scottish owl once said ‘The only thing the NHS in Scotland and England have in common is the logo and the fact that ill people go there.’ NHS in Scotland is effectively independent and doing great things for optometry. We don’t need any more independence in healthcare nor do we stand to gain professionally from achieving it.
Risk to eye care provision
On the contrary there is a risk that a positive independence vote would require careful re-examination of budgetary concerns and potentially risk the provision of eye care in Scotland. Scotland’s rural geography and scattered population make for expensive health services which could not be protected forever from treasury scrutiny. Would we need a Scottish GOC, AOP and College? The costs of supporting such bodies from a pool of only 1,000 optometrists would surely see huge fee increases. So long as we are part of the UK, our funding for health and therefore Scottish optometry is far more secure.
Now you might want extend the graph to say ‘Look what happened when we devolved health, let’s do the lot!’ That more general discussion is what we are now having in Scotland and a different set of arguments apply, but when we focus soley on optometry the case for independence is so thin as to be invisible.
From casual conversations I have with English friends, it is widely presumed that most Scots want independence and that we support the SNP direction of travel. It often surprises them when I say hardly any of my friends and social group in Scotland want the situation to change in such a dramatic way and it would be my firm contention that remaining in the UK and aiming for greater devolved powers represents the best future option for Scotland. But all that comes down to personal preferences and I have to be careful as I married a girl from England.
The yes vote: Optometry will be better off if Scotland votes yes for independence
Ian Cameron is a specialist optometrist and managing director of Cameron Optometry
