Abstract
We use the concept of ‘imagined communities’, and related work on socio-technical imaginaries and expectations, to reflect on how Scotland is represented simultaneously as ‘sick and unhealthy’ and a ‘living lab’ due to its innovative medical research. Together, we suggest these narratives have driven a broader health and wealth agenda in post-devolution Scotland, which became salient during the 2014 independence referendum. We draw on research conducted during the independence referendum to consider how key stakeholders enacted imagined communities/identities (sick but also innovative) as they considered the historical impact of devolution on health and research systems and envisioned future independence. The referendum provided an opportunity to consider how Scottish health and research systems have been imagined over time. Our findings further the understanding of the impact of devolution on healthcare and medical research, revealing the role played by policy narratives rooted in imagined identities.
Highlights
The delivery of Scottish healthcare through the devolved National Health Service (NHS) is more politicised and publicly salient than the less visible UK research system, to which Scotland contributes its scientific and medical expertise and institutional assets
We ask what specific narratives have underpinned Scottish healthcare and medical research systems since devolution, and how were these reflected in speculative and imaginative accounts of the benefits and limitations of independence? To answer, we explore the assumptions around identity and community that underlie the dual narratives of Scotland having a unique set health challenges – most recently expressed as the ‘sick man of Europe’ (McCartney et al, 2011) – and a population demographic that is used to present Scotland as a viable ‘living lab’ for the research community (Smith et al, 2006)
Accounts which prioritise either investments in medical research or basic healthcare delivery to respond to the ‘sick man’ label fail to recognise the interconnectedness of the healthcare and medical research systems, as discussed earlier; a point which is crucial to any speculative discussion about the benefits and limitations of independence to both health and research
Summary
The delivery of Scottish healthcare through the devolved National Health Service (NHS) is more politicised and publicly salient than the less visible UK research system, to which Scotland contributes its scientific and medical expertise and institutional assets. We ask what specific narratives have underpinned Scottish healthcare and medical research systems since devolution, and how were these reflected in speculative and imaginative accounts of the benefits and limitations of independence? We unpack the ‘sick man of Europe’ narrative and the ways in which it framed health policy in Scotland, before exploring the ‘living lab’ narrative to reveal how Scotland’s population was presented as a valuable resource for the clinical research community. We highlight the tensions and continuities in these particular ‘framings’ In discussing these narratives/framings, which operate at different levels, we draw on our data and policy analysis to show how they resonate in both reflections on devolution’s past, and more speculative, futureoriented discussions of an independent Scotland, anxieties around research funding, the geographical boundaries of the research system, and the complex relationship between health and research systems
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