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Last Updated: Wednesday, 2 January 2008, 00:02 GMT
NHS 'now four different systems'
By Nick Triggle
Health reporter, BBC news

Elderly people are means-tested for personal care in England, unlike in Scotland
There are now four different NHS systems operating in the UK since devolution, according to health chiefs.

As the NHS enters its 60th year, NHS Confederation boss Gill Morgan has told the BBC the health service is now in a unique position in its history.

Ms Morgan said while the underlying principles of free health care still stand, patients in the UK's four nations are getting different services.

Patient groups said the situation was breeding envy.

Ms Morgan, whose organisation represents NHS trusts and health boards, said there was no longer a universal system across the UK, as there had been when it was set up by the Atlee government in the summer of 1948.

England - NHS market created whereby hospitals and community services have to compete with the private sector for patients, resulting in big falls in waiting times
Scotland - Doctors have much more of a say in services, with limited involvement from the private sector. Meanwhile, patients enjoy free personal care, unlike the means-tested systems elsewhere
Wales - Close working relationship between the NHS and local government, which has meant more innovation on public health, but less emphasis on waiting times
Northern Ireland - Somewhat hamstrung by political situation, but re-organisation of trusts pushed through and good integration between social care and NHS

She told the BBC News website: "We basically have four different systems albeit with the same set of values.

"This period [since devolution] has been unique in the history of the NHS as it was essentially the same across the UK before devolution.

"We have had a complete split in philosophy.

"The model in England is about contestability and choice driving service improvements. Outside organisations have been brought in and patients can shop around.

"That model has been rejected by the other three."

In Scotland, where people have been given free personal care - unlike the means-tested systems elsewhere - Ms Morgan said there has been much more consensus.

She described the approach as the "collectivist model".

"They have very little contestability.

"They have been slower to improve waiting than England, but much less tension between doctors and managers.

"In Northern Ireland there has been very big structural change and more integration between health and social care."


And in Wales, which has received praise in England for introducing free prescriptions, she said the close working relationship between local government and the NHS had had an impact on public health.

She said it was too early to say which was more successful and in the coming years the differences would become even "greater".

"All we can say is that patients are experiencing different systems, each one has its advantages and we will have to wait to see what happens."

But Joyce Robins of Patient Concern said the differences were "breeding envy".

Health is the most important service devolved governments have power over
Professor Chris Ham, of Birmingham University

"Patients are increasingly looking across national borders and wondering why they are not getting the care others are getting.

"I am not sure that is good for the NHS."

Michael Summers, vice chair of the Patients Association, said England was lagging behind the rest of the UK.

"England - for some reason - seems to have been the poor relation."

And Professor Chris Ham, a former government adviser and Birmingham University heath expert, said the NHS had proved an important battleground since devolution.

"Health is the most important service devolved governments have power over."

NHS Confederation boss Gill Morgan on different systems

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