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FERGUS EWING: Bond system could end healthcare short change

By Fergus Ewing

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The struggles to get an NHS dentists are well known.
The struggles to get an NHS dentists are well known.

Last week, during the hullabaloo in Westminster, in Holyrood we debated the NHS and lack of NHS dentistry.

For the past 25 years I have seen the acute shortage in the Highlands of key personnel both in the NHS and now of NHS dentists.

In the debate I took the opportunity to intervene on speakers to put forward one major reform which other countries deploy in order to provide proper services in rural areas.

That is called Bonds. It costs about £250,000 to train a doctor and huge amounts of money to train a dentist nurse or teacher.

This cost is borne by the taxpayer.

Shortages exist in ALL these professions in the Highlands. They always have and always will I suspect – unless or until we grasp the thistle of reform.

At present very large numbers of newly qualified doctors, teachers, dentists, nurses, emigrate just after having obtained their qualifications.

So we here pay for their training – a quarter of a million for doctors as I say – and other countries benefit.

How is that fair, right or sensible? It isn’t.

In other countries there are policies whereby newly qualified doctors must practice for five years in their own country.

If they choose to leave just after gaining their qualification they are required, over a period of time, to pay back some or all of the costs of their training. Like student loans.

These obligations are contained in Bonds.

In addition, in some countries, newly qualified teachers or doctors are required to work “up country”, thus ensuring that rural schools and hospitals have a sufficient provision both of teachers and doctors – and rural dwellers are not in receipt of a poor public service.

Such a measure would allow any money raised to be invested in rural public services.

In fact the Highlands and Islands would be the soaraway gainer from the introduction of bonds with a rural obligation.

Shortages that we take as the norm could become a thing of the past.

My several interventions in the debate were fairly well received by MSPs in other parties and my own.

It is for the Scottish Government to take this forward.

My instinct is that the general public now want and expect real reform – and know that just endlessly pouring more and more cash into a creaking bureaucratic system is not going to work.

As indeed we have been warned by many independent experts, such as the Auditor General.

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