Comparing the four National Health Services

The Nuffield Trust—a think tank specializing in health issues—has just published a comprehensive report on the differences between the National Heath Services in Wales, Scotland, Northern Ireland and England. Data up until now has tended to be collected and published on a country-by-country basis, but without taking account of the sometimes wide differences between English regions. This report, by specifically comparing the devolved administrations with the English regions, allows for much more meaningful comparisons to be made.

 
     Web Page
     Summary Briefing
     Full Report

I've skimmed through it quickly, and it doesn't make very good reading. However Scotland does seem to come out of the comparison even less well than Wales, as these reports from the Herald and Scotsman illustrate:

     Scots' health service is damned as worst in UK
     Scotland sick man of the UK despite highest NHS spend

However I would caution against making the sort of hasty judgements that the media are likely to make because they, quite understandably, want to be seen as being "on top of" a report that will cease to be headline news by the time anyone has had a chance to read it properly. Bear in mind also that most of what they report will be just a reworking of Nuffield's own press release.

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The big question that will be asked—and of course needs to be asked—is to what extent the different policies pursued, and different sums of money spent, by the four administrations have affected the relative standards of service in each of the Health Services. The report does this by comparing three time points, one before the start of devolution in Wales and Scotland (1996/7) and two after (2003/4 and 2006/7) and it is obvious from looking at the graphs and tables that many of the differences were just as evident before devolution as after it. It should also be obvious that our National Health Services are still using much of the basic infrastructure that existed before devolution, so the differences have not sprung up suddenly because of devolution.

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One aspect of the report that I did find disturbing was that there seems to be a tone running through it that misunderstands the nature of devolution and the principle of devolved accountability. For example the report's authors call for the Treasury in Whitehall to be able to determine whether the policies being pursued by the various administrations offer value for money.

Now of course it is right that spending of all departments should be subject to rigid scrutiny to determine whether or not they offer value for money, but it most certainly would not be right for the governments of Wales, Scotland and Northern Ireland to be held accountable to the government that administers the services only for England. In democracies, governments are answerable to the people who elected them.

Should any of us not like the way the Welsh NHS has been run over the last ten years, that has nothing to do with devolution per se ... the answer is to vote for a different Welsh Government at the next Assembly election.