What National Health Service? According to Dr Gill Morgan of the NHS Confederation, Britain no longer has one health service but four distinctive health services, differentiated by and operating to discrete philosophies. This development was not envisaged by Sir William Beveridge, whose 1942 report laid the foundations for the NHS, which celebrates its sixtieth anniversary this year.
What National Health Service? According to Dr Gill Morgan of the NHS Confederation, Britain no longer has one health service but four distinctive health services, differentiated by and operating to discrete philosophies. This development was not envisaged by Sir William Beveridge, whose 1942 report laid the foundations for the NHS, which celebrates its sixtieth anniversary this year.
The founding principle has remained constant: the provision of treatment free at the point off delivery for citizens from the cradle to the grave. How that treatment should be organised and managed has altered. Devolution has been the catalyst for change. Britain's devolved administrations make policy on domestic matters, the biggest of which is health. In Scotland, health spending accounts for nearly half of annual public expenditure. Any administration worth its salt would want to make its mark in such a vital policy area. In Scotland, free personal care for the elderly, a distinctive if controversial policy, has been introduced. The Scottish Government aims to introduce free prescriptions by 2011. The English model is more market-orientated, with the private sector being part of the mix aimed at giving the patient (or customer) greater choice and a personalised service.
The Welsh and Northern Irish models are more similar to Scotland's, though distinctive in their own ways. What are we to make of this emerging patchwork quilt of care? It is unfortunate that yesterday's observations from the NHS Confederation have already led the Patient Concern group to warn that policy differences were breeding envy and causing people to look over borders and wonder why the services they received were not of the same standard.
In addition, Michael Summers of the Patients Association said England had become the poor relation compared with Scotland, Northern Ireland and Wales, where there were commitments to elderly care and free prescriptions. Expressions of envy are not helpful and often fail to take account of factors that cause a government to invest in particular policies. In Scotland, for instance, health spending per head of population has been higher than in England to take account of this country's geography, population spread and levels of poverty and disadvantage, both of which have a deep detrimental impact on health. It takes cash as well as commitment to tackle problems on this scale. The goal for each part of the NHS, regardless of location, must be to put as much money as is feasible and viable into front-line services. If one of the four health services was so much better and efficient than the rest there would be a risk of health tourism putting intolerable strains and pressures on the system.
But it would not be in the interests of the political administrations running the others to allow this to happen. As in previous UK General Elections, health will, somewhat paradoxically, be a decisive battleground. Gordon Brown, the Prime Minister, and David Cameron, the Tory leader, say they want to put it on a firmer institutional footing. The service has much to be proud of as it approaches 60. There is more to celebrate than bemoan about the NHS going different ways in different places.
