NHS at 60 - the devolution debate

Hywel Griffith
Health correspondent, BBC Wales

Change is nothing new in the Health Service - not a day goes past without talk of targets and improvements, of building a better NHS.

But the last few years have seen the foundations of that service shift - with political devolution in 1999 meaning things are done differently around the UK.

Some argue there are now effectively four different NHSs - one each for England, Scotland, Northern Ireland and Wales.

But how do things compare for Welsh patients - who's getting the best deal?

Spending

If you look at things in purely financial terms, it's the Scots who come out on top.

Surgery waiting lists are longer in Wales than England

Recent figures for expenditure on Health and Social Services show Scotland spends £2,313 per person, as compared to £2,109 in Wales.

Less again is spent per head in England and Northern Ireland.

But Scotland also has some of the most challenging health problems - with the lowest life expectancy in the UK, and high rates of smoking and alcohol consumption.

Ideology

Raw figures do not give you the whole picture - after all, its the politicians who decide where the money goes.

The current Welsh Assembly Government has set raised a few eyebrows by abolishing prescription charges, and scrapping car parking fees at hospitals.

"I can tell you now, sometimes across the border they look longingly at some of these policies," claims Welsh Health Minister Edwina Hart.

She's moving in a direction very different to the way the NHS is evolving in England - where foundation trusts have been rolled out to give hospital managers more freedom, and enable greater private sector involvement.

"In England they are wedded to issues like the Private Finance Initiative and getting investment that way," says Ms Hart.

"They're looking towards greater privatisation in the service and they've got other ideas which are not popular in terms of what the service wants - like polyclinics - things which are not appearing on the Welsh agenda."

Heart of the matter

But comparisons across the border don't always flatter the Welsh NHS.

For the majority of operations, there's a longer waiting list for surgery in Wales than in England, especially in procedures like hip and knee replacements.

Access to treatment in an emergency is also an issue, as recent figures on heart attack treatments show.

In England, 71% of patients were able to have clot busting thrombolytic treatment within an hour of calling for professional help, as compared to 49% in Wales.

While access has been improving in both countries, the difference is "alarming" according to the British Heart Foundation, who say inequality must be addressed.

That leaves plenty more challenges for the future, as the NHS prepares for another decade of change.