Thursday, 3 January 2008

Health: Carving up the NHS

Health and happiness in the new year is not what it seems in the countries of the United Kingdom. It looks as though while most of us were carving up the Christmas turkey, others were analysing the carving up of the NHS.

There are now four different NHS systems operating in the UK since devolution, according to health chiefs.

As the NHS enters its 60th year, NHS Confederation boss Gill Morgan has told the BBC the health service is now in a unique position in its history. Ms Morgan said while the underlying principles of free health care still stand, patients in the UK's four nations are getting different services. Patient groups said the situation was breeding envy. Ms Morgan, whose organisation represents NHS trusts and health boards, said there was no longer a universal system across the UK, as there had been when it was set up by the Attlee government in the summer of 1948.

She told the BBC News website:

We basically have four different systems albeit with the same set of values...This period [since devolution] has been unique in the history of the NHS as it was essentially the same across the UK before devolution...We have had a complete split in philosophy...The model in England is about contestability and choice driving service improvements. Outside organisations have been brought in and patients can shop around...That model has been rejected by the other three...
In Scotland, where people have been given free personal care - unlike the means-tested systems elsewhere - Ms Morgan said there has been much more consensus. She described the approach as the "collectivist model". "They have very little contestability...They have been slower to improve waiting than England, but much less tension between doctors and managers.

"In Northern Ireland there has been very big structural change and more integration between health and social care."

And in Wales, which has received praise in England for introducing free prescriptions, she said the close working relationship between local government and the NHS had had an impact on public health. She said it was too early to say which was more successful and in the coming years the differences would become even "greater". "All we can say is that patients are experiencing different systems, each one has its advantages and we will have to wait to see what happens."

But Joyce Robins of Patient Concern said the differences were "breeding envy". "Patients are increasingly looking across national borders and wondering why they are not getting the care others are getting. "I am not sure that is good for the NHS."

Michael Summers, vice chair of the Patients Association, said England was lagging behind the rest of the UK. "England - for some reason - seems to have been the poor relation."

And Professor Chris Ham, a former government adviser and Birmingham University heath expert, said the NHS had proved an important battleground since devolution.
"Health is the most important service devolved governments have power over."


England - NHS market created whereby hospitals and community services have to compete with the private sector for patients, resulting in big falls in waiting times.
Scotland - Doctors have much more of a say in services, with limited involvement from the private sector. Meanwhile, patients enjoy free personal care, unlike the means-tested systems elsewhere.
Wales - Close working relationship between the NHS and local government, which has meant more innovation on public health, but less emphasis on waiting times.
Northern Ireland - Somewhat hamstrung by political situation, but re-organisation of trusts pushed through and good integration between social care and NHS.


Wales, compared to the other UK countries, has paid much more attention to public health.

As soon as the Welsh Assembly was set up it began planning for the creation of the National Public Health Service for Wales. The service acts as an advisory and funding body for the 22 local health boards that oversee the health service. They work closely with the 22 local authorities that mirror their boundaries. It means Wales has adopted a much more integrated and forward-thinking approach to addressing public health, including school nutrition and child obesity programmes long before they became popular elsewhere.

Dr Michael Dixon, chairman of the NHS Alliance, which represents health professionals working in the community, said: "The make up of their health boards tend to be more cosmopolitan in involving local government and the voluntary sector. "This in turn has meant Wales has been much more proactive on public health."

But this push has had a consequence. Professor Ham said: "They have concentrated so much on preventing ill-health that they have been slow to address problems with the actual system."
This has meant that the Welsh Assembly Government has struggled to make progress over waiting lists.

Indeed, during the election campaign earlier this year, opposition parties picked up on the fact that there were 60,000 more patients on the waiting lists than compared to eight years ago.

The assembly government has started trying to address the situation with targets. The most recent of these is an eight-month goal for hospital treatment, but this is compared to the 18-week target hospitals in England are currently working towards.

Unsurprisingly, Welsh politicians prefer not to dwell on these figures. Instead, First Minister Rhodri Morgan crowed in January that Wales had managed to make the English jealous by introducing free prescriptions.

I'm sure that someone will correct me if I'm wrong, but I've always been led to believe that the majority of those in receipt of prescriptions in Wales [prior to free prescriptions] have always fallen into that category, and never paid for their prescription.


Anonymous 3 January 2008 at 12:29  

It's true that most were getting their prescription free before this propoganda exercise in reducing the charges over time to nil. The elderly, very young, unemployed, and those on other benefits make up the majority and always have.

There's nothing wrong with this set up, but it makes me mad to think how the government have tried to make it into such a big deal when most were getting them free in the first place.

Rod 3 January 2008 at 16:19  

Is there an area where the Assembly has stood out? I can only think of the Childrens' Commissioner; Older Persons' Commissioner; free bus passes for OAPs; free entry into CADW Museums; and breakfast for school children. That doesn't seem like much achievement in eight years.

dotcommentator 3 January 2008 at 17:05  

There is one area - economic development - where the Assembly Government has stood out for the wrong reason (i.e. hundreds of millions thrown down the plug-hole with few meaningful results).

The Assembly Government has been very good at churning out fairly neutral public sector speak and big, sweeping plans but consistently fails to measure what is going on.

Just take a look at the current Measures and Legislative Competence Orders currently on the table (see the WAG website) if you want to see - to use that appalling term - the Assembly Government's 'poverty of aspiration'. There's only ONE Measure currently proposed and that's about NHS redress for minor or middling negligence. I mentioned this once ot Jenny Randerson and she said that there was only one on the table because they took so long to progress. That's pretty unsatisfactory. The Assembly's a legislative body - why isn't it legislating?!

Anonymous 6 January 2008 at 18:33  

Is our Health Service any better for decentralisation?
If we still have the same strategic management in place then I doubt it.
If you are to bring service closer to source and this is not a bad move, then the accountability and power has to go with it, and services will vary according to the local need, so it will be post code driven, didn't they realise that?

Respectable Citizen 6 January 2008 at 19:01  

I remember reading somewhere that 40% of Welsh dentists are not acception new NHS patients. In the 60th anniversary year of the founding of the NHS, it's clear that the mantle of Aneurin Bevan does not rest on the shoulders of Ieuan Wyn Jones or Rhodri Morgan

Respectable Citizen 6 January 2008 at 19:04  

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Tomos 7 January 2008 at 18:20  

If you don't live in the South Wales area or near the border then your health is in trouble in an emergency. God help you if you fall ill in Merthyr.

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