While I expected the ‘no’ result, the vote was much closer than I had anticipated. Westminster certainly had to make more promises in terms of what it was prepared to give Scotland in order to secure that result, and the most important thing to stress is that what happens next is entirely unclear. Although the main political parties in England made a commitment for more devolution to Scotland, there is no agreement among them with regards to exactly what is to be devolved.
For example, The Institute for Government is presently considering nine possible scenarios for how this is all going to play out. The Institute for Government is the UK’s leading independent charity and think tank promoting more effective
government; very reputable and nonpartisan. The fact that it is looking at nine different scenarios underlines the uncertainty we face.
What is clear is that Scotland will have more say and control of their tax-raising policies and how those taxes are spent in Scotland. In the areas of health and the NHS, this could lead to increasingly divergent policies compared to the rest of the UK. There are differences already between the NHS in England, Scotland and Northern Ireland of course, but I believe they are likely to become significantly greater and more magnified.
As far as dentists are concerned, where they are based will determine what their relationship with the health service is going to be. It really is too early to say how the result will affect individual practices; all that is certain is that the manner in which a NHS dental practice is operated in Scotland and in England will become increasingly different. Specifically in what ways, we are yet to find out.
So, what are the positives to come out of this? Well, the fact that the union has been preserved for one! We have a larger economy overall, we are a bigger player on the world stage, with less uncertainty about markets and currencies; a more stable
business environment for practices to operate in. If Scotland had gone its own way, there would have been greater uncertainty and many more changes than we face now. For dental practices, this could have affected the cost of materials, may have impacted on wages and even caused employees to think about relocating elsewhere.
For practices north of the border, we may now be looking at different business models for England and Scotland, which means taking different advice from specialist accountants and lawyers as the process of more devolution unfolds.
There is an aggressive timetable to finalise devolution, forged from the commitment made by Westminster in advance of the referendum to secure the ‘no’ result it wanted. Now we have the result, everybody is under pressure, especially in light of the
General Election in May. The good thing about that, however, is that the period of uncertainty is likely to be shorter than it otherwise could be. While I believe some promises will be kept and the first changes will be implemented in January 2015, in reality some issues are more likely to be resolved after this.
What also seems to be coming out as a consequence of the debate is that England may have less influence from non-English MPs. If English MPs get more autonomy this could influence the NHS in England, particularly since – at the moment – England is Conservative, unlike the rest of the UK.
As far as advice I would offer practices in the coming months, it’s really just ‘wait and see’. I would also highly recommend staying on top of any new information as it becomes available. Be vigilant about what is going on and how your practice may need to be arranged to accommodate changes that haven’t happened yet. Keep in touch with your accountant and lawyer, and read the dental publications for regular updates. Such situations is where the benefit of using specialist dental accountants or solicitors becomes clear, because they will know and fully understand potential changes and how they may affect their clients. For those practices that do not have a specialist accountant, maybe this is an appropriate time to seek support. No one knows for sure how increased devolution is going to pan out, and it is important to have professionals around to help and support you in a specific way.