Forget independence. Forget devolution. There is no bigger issue in Scotland than health. It is often said that the NHS is a religion in England, but this is even more true in Scotland. In 2014, then-First Minister Alex Salmond significantly boosted support for independence thanks to his declaration that the NHS would be “privatised” if Scotland remained in the Union. Yet now the service is effectively being privatised by the Scottish National Party.

At least that was the assessment of the head of the Scottish BMA, Dr Iain Kennedy, during an address to the medical union’s national conference in Liverpool on Tuesday. Kennedy revealed research confirming what everyone suspected: that more and more Scots are being forced to go private rather than languish in pain on ever-lengthening waiting lists, which now account for more than one in 10 adults in the country.

According to a survey of 1,203 respondents by the Diffley Partnership, a third of Scots say they or someone else from their household have had to resort to private health in the past two years. What’s more, 17% had actually accessed private medical care and 14% said a member of their household had.

Kennedy claimed it is now “abundantly clear” that there is a two-tier service in Scotland, and that the divide represents creeping privatisation of the NHS north of the border. Except Scots are not so much creeping as voting with their feet, fast: the numbers going private have increased threefold in the last four years.

This represents not just elective queue-jumping, but also a radical change in attitudes to a service that is supposed to be free at the point of need. Confidence has been lost: 46% of Scots who do not use private healthcare now say they would go private if they could afford it. “The NHS is dying before our eyes,” Kennedy said on Tuesday.

How did we get here? Scotland used to have the best-financed and most highly regarded health service in the UK. Yet now nearly one in six Scots are waiting for treatment, according to Scottish Labour Deputy Leader Jackie Baillie, often in considerable pain and discomfort. Just getting a place on an NHS waiting list is difficult enough. Rather than wait years for elective surgery, people are being quietly advised by their GP to go private if they want early relief.

The SNP government invariably blames “Westminster austerity” for its failure to meet its own supposedly binding targets for care. But the Scottish government receives over £1,500 more spending per head than the overall UK figure, according to the latest Treasury figures. Money has never been the issue here.

Really, the NHS has deteriorated rapidly in the last decade, despite generous pay awards in Scotland to doctors and nurses who earn significantly more than their English counterparts. Since the pandemic, NHS productivity has declined, despite there being 13% more consultants and 12% more nurses than in England, according to the Institute for Fiscal Studies.

Then there is the crisis in social care, with up to one in 10 NHS beds occupied by an often elderly patient who should not be there. But the awkward truth is that the nationalists have been diverting finance from the NHS to fund their other social programmes. At the dawn of devolution, Scotland spent 22% more on health than England. By 2019, that had fallen to just 3%.

These figures demonstrate that the Westminster austerity claim simply does not wash. The SNP cannot blame anyone but itself for the collapse of trust in the NHS in Scotland. But this is electoral kryptonite for the nationalists. Their failure on health towers over their other shortcomings in education, public procurement and housing. It really is a matter of life and death, and behind the figures lies untold human suffering.

The SNP government cannot now avoid a reckoning in next year’s Scottish Parliament elections. Party support has been in steep decline, as evidenced by its loss of the previously safe seat of Hamilton, Larkhall and Stonehouse earlier this month. If, after nearly two decades in office, the nationalists are humiliated next year, it will be health — not separatism — that has put them there.

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Iain Macwhirter was political commentator for The Herald between 1999 and 2022, and is the author of Disunited Kingdom: How Westminster Won a Referendum But Lost Scotland. He was Rector of the University of Edinburgh from 2009-12.

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China is trying to catch up with America on artificial intelligence. The Wall Street Journal has reported that Zhipu AI — one of China’s six “AI tiger” LLMs — has released a new model that can rival leading US systems, including Anthropic’s Mythos, in cybersecurity tasks such as pinpointing security bugs. While this marks a milestone in China’s drive to catch up with Western AI capabilities, strong performance on a single benchmark does not mean it has taken the lead. Chinese models still lag behind their Western counterparts in broader capabilities, such as autonomous operation. Skepticism is therefore warranted before resorting to hysterical conclusions, but complacency about the geopolitical implications of China’s AI advances would be an even greater mistake.

On the infrastructure side, Chinese AI is still constrained by access to advanced chips, with American labs way ahead in computing capacity as well as investment. Analysis from earlier this year suggests that Chinese models are likely to be at least a few months behind those in the US. But they are still continuing to make progress, or that the geopolitical importance of AI will be decided only by whose LLM has ventured deeper into the technological frontier. The practical applications of AI, countries’ to capture foreign markets, and the application of AI into the real economy will matter just as much.

Here, China may hold an advantage. As with its dominance across many critical supply chains, Beijing may not need to produce the most advanced AI systems — only those that are affordable and widely deployable. In doing so, it could consolidate global influence by supplying functional, low-cost AI at scale.

Beijing seems to be pursuing exactly that path, developing an AI “open-source” strategy that offers affordable, widely available AI models for companies and individuals to use and modify as they wish. The production of the DeepSeek AI model, which matched the performance of Silicon Valley tools such as ChatGPT at a fraction of the cost for users, created goodwill among Chinese models with developers.

The four most popular models on OpenRouter, an AI hardware platform for developers, are now all Chinese. The goal for China is not only to win the frontier-model race, but to make its systems the default layer of AI adoption across industries and global markets. For most economies, the choice is increasingly between an affordable tool they can deploy now and a more robust one that may be out of reach.

And while the countries adopting Chinese models may be exposed to political pressure and cyber threats from Beijing, safer and more capable alternatives matter little if they are unaffordable. American AI companies are already under pressure to monetize products whose operating costs are rising. If Chinese open-source models become the cheap default for startups, universities, governments and businesses across the developing world, then America’s AI lead will be eroded from below.

Perhaps more concerning for America in the long run is how AI can give Chinese manufacturing even more strength, through the ongoing integration of AI as a general-purpose technology. China’s new Five-Year Plan mentioned AI more than 50 times and includes an “AI+” action plan aimed at spreading AI across the economy.

Beijing has been pioneering automation of its critical infrastructure for years, with promising recent results in increasing warplane production capacity. In that regard, China’s open-model strategy and manufacturing dominance will reinforce each other. Cheap, adaptable models accelerate deployment across the real economy while those deployments generate real-world data and use cases that can feed back into further model improvement.

The United States should not dismiss the importance of its lead in the AI race. That lead worries Beijing, not least because a more automated Chinese economy would also become more vulnerable to AI-generated cyber threats. But nor should Washington assume that China cannot catch up with American capabilities over time.

This AI competition represents part of a broader struggle over tech supply chains and geopolitical influence. Decisions over whether to adopt US or Chinese models could produce a more fragmented global reality, with different regions relying on different cloud providers, chips and security structures. The result will likely be a global economy which is divided into competing spheres, rather than one which produces a single winner.

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Miquel Vila is a political and geopolitical risk consultant focusing on industrial strategy, critical infrastructure and global supply chains.

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