Scottish Independence

[Viking]

The "N" in NHS is National. Some duties have been devolved, but those are the ones which resided with the secretary of state for scotland before. On the NHS Scotland wikipedia site recent developments include an orthodontics research program, limiting the scope of cooperation with private companies, the only example of which is free parking at hospitals. Not exactly any core issues at stake here.

There's no such body as the NHS. There is the NHS (England), NHS (Scotland), NHS (Wales) and Health and Social Care in Norther Ireland.

All policy, including funding, is set by the devolved assemblies, except for the English NHS where it is set by the UK Parliament.

Yes, but the devolved bodies can't change the level of care provided or the basic funding of the NHS. They can arrange how they themselves pay for it. They cannot reduce the level of service they choose to provide nor who they provide this service too. This is not like the universities where they can make englishmen pay more or deny them certain treatments they give to scots.

[Tamas]

Having the NHS done at a national rather than UK level seems wasteful and inefficient to me.  What is the thinking behind that?  Isn't the idea that standardization and an economy of scale will keep costs down?  What if you live and work in Wales and the nearest Hospital is in England?  It just seems so illogical to do it that way.

Excuse me but what should they do with all the local and national leadership positions, probably full of people with the right connections, which would go redundant if they make things cross-UK, ha? Be reasonable, mate.
All state-ran things are overbloated because politician's friends also need to eat well, you know.

[Gups]

The "N" in NHS is National. Some duties have been devolved, but those are the ones which resided with the secretary of state for scotland before. On the NHS Scotland wikipedia site recent developments include an orthodontics research program, limiting the scope of cooperation with private companies, the only example of which is free parking at hospitals. Not exactly any core issues at stake here.

There's no such body as the NHS. There is the NHS (England), NHS (Scotland), NHS (Wales) and Health and Social Care in Norther Ireland.

All policy, including funding, is set by the devolved assemblies, except for the English NHS where it is set by the UK Parliament.

Yes, but the devolved bodies can't change the level of care provided or the basic funding of the NHS. They can arrange how they themselves pay for it. They cannot reduce the level of service they choose to provide nor who they provide this service too. This is not like the universities where they can make englishmen pay more or deny them certain treatments they give to scots.

Not only can they, but they already do. They set the funding and they set policies for teh various NHS trusts to follow.

For example, in England there are quasi-markets in health care. To an extent, patients can choose their doctors and hospitals. In Scotland there is not. In England there are prescription charges. In Scotland there are none. IN England care for the elderly is means-tested. In Scotland it is not.  In England pricate providers can operate. IN Scotland they can't.

Here's what NHS Scotland says:

"Responsibility for the National Health Services in Scotland is a devolved matter and therefore rests with the Scottish Government. Legislation about the NHS is made by the Scottish Parliament. The Cabinet Secretary for Health and Wellbeing has ministerial responsibility in the Scottish Cabinet for the NHS in Scotland.

The Scottish Government decides what resources are to be devoted to the NHS, in the context of devolved public expenditure. Of approximately £34.7 billion controlled by the Scottish Government, around £11.9 billion is spent on health*.

The Scottish Government sets national objectives and priorities for the NHS, signs delivery plans with each NHS Board and Special NHS Board, monitors performance, and supports Boards to ensure achievement of these key objectives.

NHS Boards in Scotland are all-purpose organisations: they plan, commission and deliver NHS services and take overall responsibility for the health of their populations. They therefore plan and commission hospital and community health services including services provided by GPs, dentists, community pharmacists and opticians, who are independent contractors."

http://www.ournhsscotland.com/our-nhs/nhsscotland-how-it-works

You are right that none of the NHS bodies would refuse emergency care to anyone on the basis of nationality but that is simply because they have the same policy. In theory any of the devlolved assemblies (Parliamnet in the case of England) could refuse to treat non-natives, subject to professional and political fallout.

[Tamas]

I know I am making broad assumptions but it seems pretty likely that such an irrational setup is the result of no national body willing to relinquish control over a cashcow like healthcare, interests of the general population be damned.

[Josquius]

Health care....cash cow?

[Admiral Yi]

I think you're being loopy Tamas.

[Tamas]

Cashcow in terms of opportunities for people put in charge of the tons of money needed to be spent on it.

[Gups]

There are certainly plenty of complaints that a disproprtionate amount of money is spent on adminsitration in the NHS.

I'm not sure it would be any better if all hospitals, suregeries etc were run centrally.

[Valmy]

There are certainly plenty of complaints that a disproprtionate amount of money is spent on adminsitration in the NHS.

I'm not sure it would be any better if all hospitals, suregeries etc were run centrally.

Well the whole benefit of having a commie health care system is standardized equipment and care that cuts costs.  If things are slightly different between Scotland and Northern Ireland that creates inefficiencies.  This is a nightmare when you do healthcare across all 50 states (well really 51 because DC does its own thing to) like some insurance companies here do.  I am not sure why somebody would want to recreate that.

[alfred russel]

I think you're being loopy Tamas.

I get the general point he is making. It used to be that the UK was a relatively unitary state with an elected parliament.

Now it still has that parliament, plus membership in the EU parliament. Plus now England, Scotland, Wales, and NI will apparently need their own parliament. Plus apparently powers have been devolved to some extent locally, and there are more elected officials at that level as well.

The result is significantly improved opportunities for your average politician to find elected employment. Is all of this also resulting in improved laws, governance, public engagement, etc?

[Grey Fox]

The UK, it's turning into...France?!

[Sheilbh]

Pensions: No reason why they won't be devolved

Pensions'll stay national. I don't see a way we could have someone in Wick on a lower state pension than someone in Whitby, and I think that's normally the part of social security that is federally administered in other countries. Though the rest of DWP would be hived off.

Having the NHS done at a national rather than UK level seems wasteful and inefficient to me.  What is the thinking behind that?  Isn't the idea that standardization and an economy of scale will keep costs down?  What if you live and work in Wales and the nearest Hospital is in England?  It just seems so illogical to do it that way.

As a patient it doesn't matter. You go to the nearest hospital or register at your nearest GP - free at the point of need. But they're administrative units who are run in different ways. The English NHS is moving far more towards an internal market, private sector involvement and the like and is split into lots of Primary Care Trusts with their own budgets, while Scotland's rather more monolithic.

I get what you're saying about efficiency but if you've got a centralised NHS entirely administered from London then I think the gains you make in efficiency may well be lost in inflexibility and bureaucracy. So all the PCTs can take advantage of the NHS' purchasing power but also choose to manage their budget to meet the particular needs of their area - in theory.

I also don't think the common criticism of the NHS as spending too much on administration is necessarily right (I believe in international comparisons we're very low and the criticism actually leads to medical staff working on admin rather than hiring admin staff to do it for them), or would be helped by a huge post-war style Ministry of Health.

[celedhring]

I thought that the NHS had a pretty good coverage/spending ratio?

[Sheilbh]

I thought that the NHS had a pretty good coverage/spending ratio?

According to some international comparisons the best in the world at that sort of thing.

Personally I don't buy the whole 'envy of the world' nonsense. But I think it gives pretty decent care for a relatively low amount of spending. Which is roughly what British people want I think.

[mongers]

Regarding his on air comments about HMQ, does Cameron secretly want to break up the Union or is he just putting in a late entrance for the 'Upper Class Twit of the Year' games?


My preferred solution to the developing parliamentary/constitution crisis is the same buildings used by slightly fewer politicians. This would be achieved by the current 635/650 seats up for grabs in a UK general election, all MPs attend the same UK parliament meeting in the Commons when it's dealing with UK matters.

When laws/matters that are dealt with differently/devolved in the four countries are discussed, the English MPs sit in an English parliament in the Commons and the other MPs sit in their respective parliaments in Scotland, Wales and Northern Ireland.

Regarding the funding 'bias'/distribution, that's a matter to be decided upon anew by the next UK parliament. The Barnet formula has served it's function, we need a generational reaffirmation or reallocation of resources to the more economically disadvantaged regions.

I'm not in favour of English regional assemblies, as it'll generate yet another layer of lackluster, if not openly inept and/or corrupt politicians.