An NHS divided?

A basic guide to the differences in NHS care between the countries of the UK.

What are these differences?

Put simply, the NHS in ENGLAND and NORTHERN IRELAND believe in patient choice and encourage competition between healthcare providers, to the point of inviting in services from the private sector, e.g. Virgin Healthcare. One notable point of difference has recently arisen with an announcement from Northern Ireland health minister Michael McGimpsey that prescription charges are to be abolished by April 2010.

In SCOTLAND, the NHS internal market was formerly abolished in 2003, with trusts replaced by health boards responsible for working in partnership with local authorities, communities and patients. This is seen as an integrated, cooperative model rather than a competitive one. Free personal care services - such as washing, cleaning and dressing - for the elderly has also been introduced and ministers have announced an end to hospital car parking fees. Prescription charges are to be phased out by 2011.

In WALES health minister Edwina Hart is proposing a wholesale reform of the structure of the NHS with a new national advisory board whose members will be chosen by the Assembly government. The body will meet in public and disagreements over issues such as availability of drugs debated openly. Prescription charges were abolished in 2007 and the phasing out of hospital car parking charges is to follow by 2011.

Why the differences?

The devolution of powers amongst the countries of the UK in the late 1990s meant that the Scottish Parliament and the Assemblies in Wales and Northern Ireland became responsible for their countries' healthcare provision.

The Westminster government believes that competition between GPs, hospitals and other care providers would lead to cuts in costs and increases in efficiency, giving the consumer - i.e. the patient - the best possible choice of healthcare providers. The Scottish and Welsh health services, on the other hand, have emphasised the social benefit rather than economic efficiencies.

So which system is better?

The big question. The health services of the four nations are clearly going along differing lines, to a lesser or greater degree. Scottish health secretary Nicola Sturgeon stresses "the values of public service, of co-operation and collaboration", the Welsh Assembly Government's One Wales document rejects the "organisation of [the NHS] on market models" and promises to tackle health inequalities, while in England choice remains a key principle.

What's wrong with efficiency?

Nothing, assuming they really are efficiencies. By introducing private health groups such as Virgin, the NHS is inviting companies whose primary concern is to ensure a profit for themselves and a positive dividend for their shareholders. The most obvious way that they can both do this and present themselves as a cheaper alternative is by cutting costs.

The fear is that inexperienced GPs are used because they cost less; nursing and secretarial staff are cut back; and cleaning staff are outsourced (leading to the possibility of MRSA-style infections). All in the name of "efficiency".

Surely this is scare-mongering. Isn't this our national health service?

Sixty years ago, the idea of the NHS being split into separate but distinct geographical areas would have been unthinkable. This is the shape of things to come: no longer a National Health Service, but a regional one, where your health care depends on where you live.

Now, with Lord Darzi's proposed "polyclinics" or super-surgeries, we are looking at yet another once-unimaginable prospect: of 150 new health centres run largely by private concerns. These aren't charities or services. These are businesses, designed for profit.

If the NHS really does need saving, what can we do?

Now that's for another page…



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