The Death of the NHS It’s 60 Years Since the National Health Service Was Set Up . . . But Has Devolution Changed It Forever?

By JUDITH DUFFY

PRESCRIPTION charges have been scrapped in Wales and will soon be abolished in Scotland under plans by the SNP.

Yet, in England, many patients will continue to pay for medicines.

Health watchdogs north of the Border have approved the use of a “sight-saving” drug called Lucentis but patients in England are still awaiting a decision by the equivalent English body.

Last month prime minister Gordon Brown announced his vision of a “personal and preventative” NHS, with the setting-up of a screening programme for some of the UK’s biggest killers for patients south of the border.

It’s been 60 years since the National Health Service was set up, on founding principles of free healthcare available to all and of uniform quality, regardless of where people lived or their background.

But now it appears the care available on the NHS is becoming increasingly varied, according to which part of the UK you live in.

Many commentators anticipated devolution would have little impact on health, arguing that different health policy processes have always existed. However, with the 10th anniversary of the Scottish parliament approaching next year, concerns are being raised that the National Health Services is splintering into the four corners of the UK.

Earlier this month, patient representatives even claimed a form of medical “apartheid” had been created in the past decade, due to widely differing provision of care.

Dr Peter Terry, chairman of the BMA in Scotland, agreed the health system in Britain has reached the point of having more differences than similarities.

“I don’t think divergence is an appropriate term any more, I think it is complete separation, ” he said. “They are now so different that it is no longer the UK NHS we have NHS Scotland and they have something else.” A major focus of the Department of Health in Westminster has been on providing quick access and speedy treatment. It has brought more private providers into the NHS such as independent treatment centres believing creating competition will improve performance.

In Scotland, the emphasis has been on the system of partnership working which has included the abolition of trusts and the introduction of unified health boards. While the previous Labour administration had begun to introduce the use of private firms to cut waiting times in Scotland, health secretary Nicola Sturgeon has pledged there will be no more expansion of private healthcare to treat patients in Scotland.

Terry argued the model in Scotland was better than the “alien healthcare system” which has developed in England.

“I don’t think everything is perfect in Scotland by any stretch of the imagination, but, in terms of the way we have evolved our health service especially the emphasis on partnership and co- operation we are doing okay, ” he said. “I don’t think I would recognise it (the English health system) as the National Health Service, to be honest.” Campaigners south of the Border have raised concerns that England is becoming the “poor relation” in the NHS. Speaking earlier this month, after a debate on the issue was triggered by the NHS Confederation, Michael Summers, vice-chairman of the Patients Association, said: “We should follow best practice – which they have discovered in Scotland, Wales and Northern Ireland.” Terry acknowledged that varying provision in the NHS could lead to resentment being a problem. But he added: “If there is resentment, there is always the suggestion you should downgrade those who appear to be getting more and I would hate that to happen.”

Dr Jean Turner, a former GP and chief executive of Scotland’s Patients Association, said there had always been some element of separation in the health service in Scotland because of differences in geography and population.

“From a general point of view, I see devolution as being better because you can make decisions closer to home, ” she said. “If you look at the way things have gone in the health service in England, the bringing in of the private sector has in many ways destroyed the health service.

“The pathway we have been going down in Scotland has prevented a great deal of infiltration by the private sector, although it is there.” Turner pointed out one potential difficulty of having varying levels of healthcare provision across the UK particularly for those living near the borders is people trying to use the benefits of a neighbouring system.

But she pointed out: “In Wales there was the worry about people deliberately coming over for free prescriptions, but they had different prescription pads which made it very obvious.

“I think these are subjects for debate and refinement, but I don’t think they are big enough problems.” Theresa Fyffe, director of Royal College of Nursing Scotland, agreed that health policy is diverging, but argued this was a “natural process”.

“Since the Scottish parliament was set up, health policy and the way health services are delivered have diverged to meet the differing health and cultural needs in the four countries, ” she said.

“If you are truly looking at the health needs of your population, you would change your policy and your service delivery to meet that so it wouldn’t be very surprising to me that has happened.” An element which has been missing in the “one-sided” debate, argued Fyffe, is the opportunity for the four countries to learn from each other. She pointed to the example of the ban on smoking in public places, which was initially implemented in Scotland and subsequently adopted in the rest of the UK.

“Where the divergence will happen is because it is in response to health and population needs, but I don’t believe that means there won’t be some things which will be in common, ” she said.

“There is research which has been done which is good, but instead of looking at it and saying this is what is different, why don’t they look to see where are the common policies and where is the sharing?

“We only talk about what is different and perhaps don’t quite understand how we are working and engaging a lot more collaboratively.” She added: “I see devolution not as a threat at all, I see it as an opportunity to share best practice.” An example of this was highlighted last month when the Commons health committee called for the National Institute for Health and Clinical Excellence (Nice) which recommends the treatments that can be made available on the NHS in England, Wales and Northern Ireland to adopt a similar “fasttrack” approach to Scotland’s medicines watchdog when assessing new drugs.

While the Scottish Medicines Consortium last year approved Lucentis, a drug that can help restore sight to people diagnosed with a condition known as wet age-related macular degeneration (AMD), many patients elsewhere in the UK are still awaiting health boards to be issued with final guidance from Nice.

Barbara McLaughlan, campaigns manager at the Royal National Institute for the Blind, said it was good news that Lucentis was available in Scotland.

“However, many people with wet AMD in other parts of the UK are battling to get the treatments they desperately need to save their sight, ” she added. “It is appalling that these patients are effectively being told to pay for private treatment or go blind.

“Why do people in England and Wales have to wait for more than two years for a decision when the Scottish Medicines Consortium took a mere three months to approve these treatments?” It is patients like these who may be left questioning what has happened to the idea of a national health service.

Raymond Liggins, a 76-year-old from Nuneaton, Warwickshire, has been forced to use his life savings to pay for Lucentis after his local NHS trust refused to pay for the drug. He said he hoped Nice would follow the example of its Scottish equivalent.

But he added: “I don’t feel bitter that it is available in Scotland at all good luck to them.” Meanwhile, the Scottish government claimed the key elements of Brown’s screening programme are already being progressed in Scotland.

Sturgeon said: “We are already addressing health inequalities through the Keep Well Programme, which targets 45 to 64-year-olds in the most deprived areas and identify vascular and stroke risk.

“Scotland is also well served by a comprehensive range of screening programmes, including the roll-out of a bowel cancer screening programme to all 50 to 74-year-olds.”

Originally published by Newsquest Media Group.

(c) 2008 Sunday Herald. Provided by ProQuest Information and Learning. All rights Reserved.