Page last updated at 16:08 GMT, Tuesday, 8 July 2008 17:08 UK

Is the Scottish NHS really the best?

By Nick Triggle
Health reporter, BBC News, Edinburgh

Medical money
There is concern the private sector is motivated mainly by profit
Doctors, it seems, love Scotland.

They have spent the week praising the approach taken by the government north of the border while attending the British Medical Association's annual conference.

BMA chairman Dr Hamish Meldrum kicked it off on Monday when he told doctors that England could learn a thing or two from the approach taken on NHS reform.

He said while ministers in Whitehall had embraced the private sector, their Edinburgh counterparts had showed how it could be done without conflict and fragmentation of care by shunning firms in favour of collaboration with doctors.

And on Tuesday, Scottish health secretary Nicola Sturgeon received a warm welcome when she addressed a fringe event with some doctors telling her that they wanted to come to work in Scotland.

Not perfect

But is it all as rosy as it seems?

Free personal care was a flagship policy - but there is a large variation in eligibility
Lewis Morrison
Geriatric consultant

People in England often look enviously at the way the social care system is run in Scotland.

After devolution, the Lib-Lab coalition decided to provide free personal care, which covers basic assistance with washing and dressing.

This is means-tested elsewhere in the UK, meaning many find themselves going without or paying for help.

But, as doctors point out, the situation is far from perfect in Scotland.

Lewis Morrison, a geriatric consultant in East Lothian, says people are finding it increasingly hard to get access to services.

"Free personal care was a flagship policy. But there is a large variation in eligibility. There is a postcode lottery and mutterings about the long-term viability."

Waiting lists

And officials at London's Department of Health can no doubt be heard grumbling: "what about waiting lists?"

While doctors may prefer the private sector out of health service, most are agreed it has played at least some role in reducing waiting lists.

Scotland is not doing as many operations or seeing as many patients and this is despite the greater health needs
Professor John Appleby

By the end of the year, patients in England should be guaranteed hospital treatment within 18 weeks, compared to waits of over two years just a decade ago.

Scotland, by comparison, is not due to reach such a milestone until 2011.

Scotland also comes out worse when you consider health measures.

Glasgow, famously, comes bottom of most life expectancy tables, but even when you take the overall figures Scots can expect to die two years earlier than the English.

Of course, on any public health measure Scotland will quite rightly point to the fact that it faces higher levels of deprivation and inequality which largely determines these health outcomes.

And this is reflected by the fact that per head Scotland gets more health funding than England - 1,919 compared to 1,676.

This means many of the strains and tensions seen in England are relatively unheard of in Scotland.

More doctors

With about a third more GPs per head, Scotland has not faced the outcry over access to family doctors that has set the profession and ministers on collision course south of the border.

There are also 21% more consultants, 30% more nurses and 65% more beds, according to an analysis by the King's Fund.

However, as always, it is not that simple. King's Fund chief economist Professor John Appleby says: "If you look at the activity levels, Scotland is not doing as many operations or seeing as many patients and this is despite the greater health needs."

But, equally, England faces an issue with emergency readmissions which many say is related to the fact that there is so much pressure in the system that hospital patients are forced out of beds before they are ready.

Professor Appleby admits the figures are "crude", but he adds: "Really it is very hard to tell which system is best.

"But I don't think it is quite as straightforward as is being suggested."





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