SNP president Michael Russell advocated health care privatisation in book written with party donor

It comes after the Herald on Sunday revealed how private health care hospitals and firms are being invited to bid for the provision of 1500 procedures in vital medical care including lifesaving surgery normally carried out by the NHS in Scotland.

Scottish Government quango NHS National Services Scotland (NSS) has been sanctioned to create a dynamic purchasing system (DPS) for private firms to provide surgery and other medical care across the health care spectrum in a move that some fear sets a pathway for privatisation of the NHS.

Would-be contractors have been told that health care support could even be provided outside of Scotland.

Some £150m has been set aside that will cover five years of the system aimed at supporting services within the NHS.

In the 2006 book Grasping the Thistle, Mr Russell, who when it was published was an SNP parliamentary candidate for Dumfries having previously been and MSP for the south of Scotland from 1999 to 2003, sets out how Scotland "must react" to key challenges of the 21st century.

Its radical vision for the NHS talks of replacing NHS hospitals with privately run clinics, the introduction of payment vouchers so people can get treatment where they wished in a plan that would make the health services in Scotland a "national asset".

It talks of a “re-think” of the “prevailing Scottish orthodoxy which  continues to hold that health, and education - and some other services - must still be delivered virtually exclusively by the public sector".

READ MORE: Scots NHS for sale: Firms invited to bid for over 1,500 Scots medical procedures

“We believe it is in the interests of every consumer of government services for us to rethink our national approach.  It will lead to great efficiency and better services for all," it says.

“In reality Scottish public services remain organised, by and large, in the interests of the service providers, not the consumers.  That leads to waste, duplication, empire building and inefficiency.

"We would encourage the private sector to compete with established NHS hospitals, clinics and other services. We would encourage NHS management and staff to buy out existing NHS facilities and services under favourable financial terms and join the private sector," it said.

"We would require NHS facilities that remained in government ownership to be run at a profit however modest. Those that failed to maintain profitability over a reasonable time frame would be privatised.

"In each geographic area the government would solicit bids from the area’s medical facilities and GPs for the various services it required for its citizens.

"Fragmentation of services may well see the redundancy of large general hospitals and their replacement with privately run clinics specialising and competing in particular medical procedures and services, at least in the more populated areas."

The SNP's 2015-16 programme for government, which set out the Scottish Government’s plans for the year ahead, pledged to "effectively eliminate use of the private sector for planned care" as part of a 20-year strategy.

And in 2017 Nicola Sturgeon told SNP conference delegates that “as long as the SNP is in office, the NHS will always be in public hands".

Nicola Sturgeon has vowed to keep the private sector “at the margins”, suggesting that UK Government threatens public ownership of the NHS.

Leading care expert Nick Kempe, a former head of service for older people and adults in Glasgow and convenor of think tank Common Weal's Care Reform Group, said the commentary was a concern in the wake of the 'NHS for sale' revelations.

"Despite the statements that the NHS would be safe with the SNP, there are bits of government and the SNP that now cannot think of doing anything without involving the private sector," he said. "In other words what Mike Russell said back then is an illustration of much wider thinking that has now taken over the SNP. "The result is that there is now an inevitable drift towards privatising everything even where Nicola Sturgeon says they won't."

The book states that one idea that is worth further consideration is the possibility that some provision may be supported by payment vouchers "made available free of charge to citizens in order that patients would receive treatment wherever they wished".

"Citizens who wished to make their own arrangements with medical service suppliers would be free to do so. Armed with their voucher they could shop for the fastest and best service and if they so wished add to the value of the voucher."

READ MORE: Scots ministers 'break law' over award of new National Care Service contract

To underpin the freedom, the authors said they would expect in those circumstances that a system would be established in which no citizen would or could be refused provision.

"Need will result in services, just as in the early days of the national health service. But the provision of service might well be faster, better and more effective," they said.

Under a "more market-based approach" an individual armed with the power of the consumer and vouchers which will meet the cost of the best treatment, would "quickly find the right place to go".

The book states: "We believe such changes would established a competitive, efficient and cost-effective health services. We are not suggesting that government should withdrawn from the funding of medical costs but only that it should withdraw from the complete control and management of such services.

"The fact that we were, post war, the innovators in national health care does not mean that our original innovation is still the best model, or the one that can perfectly suit present and future times. To claim that is to take conservatism (real conservatisim which fears change and resists improvement) to its ludicrious limit. There is nothing radical, let along progressive in so doing.

"Medicine and health are areas in which Scotland has traditionally excelled. We believe that the establishment of a health delivery service as proposed with the elimination of corporation tax and low incomes taxes could well result in Scotland becoming once again a centre of medical excellence.

"Our medical companies, and others attracted to our shores by the opportunities available, would not only be providers of medical services to the Scots, but could also become a major force in business providing leading-edge medical services to the international community.

"Such a nucleus together with our low-tax regime could also become a magnet for the world's best practitioners at all levels. If only we could think big and plan accordingly our health service could be transformed from a major problem to a national asset."

The substantive work on the book was undertaken before Mr Russell was selected to stand for the SNP in the 2017 Scottish Parliamentary elections.

The book was planned in late 2004 when he and Mr Russell discussed his return to an active role in the SNP and to becoming an MSP.

He then acknowledged that they had put forward some "radical and far-ranging options which would alter the nature of our democratic process and lay requirements on ordinary citizens that some will find surprising".

"We were also acutely conscious of the fact that the SNP leadership campaign which had concluded some months earlier with the re-election of Alex Salmond had thrown up lots of new ideas," he wrote.

"In particular we knew that there was once more a developing sense of curiosity about nationalism and that there was a need for some fresh thinking with regard to Scotland's national prospects."

In an author's note Mr Russell, who was elected president of the SNP in 2020 before standing down as an MSP ahead of the 2021 Holyrood election, emphasises that nothing in the book was being proposed as SNP policy and was not meant as criticism.

The independence unit Mr Russell heads up was unveiled in January, with depute leader Keith Brown saying it would create policy papers and campaign materials to "fire up" the Yes movement.

The First Minister said: "Delighted that the SNP's National Executive Committee has approved my nomination of Mike Russell as political director of the HQ independence unit.

"He will oversee the development of the party’s independence campaign, as we look ahead to #indyref2 later in this Parliament."

Mr Kempe said the results of competition in health services had already shown itself in the social care sector with lack of staff training, low pay and terrible working conditions.

He said of the commentary: "It ignores the fact that outsourced services are run in the interests of providers, not staff and not the public, as we can see from more and more providers moving into tax havens.

"The claim that public services lead to waste, duplication etc is mind bogglingly wrong. If you have one service you have one management structure, if you have two services each has their own management structure but the commissioning body also needs their own manager, ie you immediately have three sets of managers not one! You can see some of that in the NSS tender."

The SNP and the Scottish Government were approached for comment.