BMJ 1999;318 ( 1 May )

Editor's choice

The excitement of devolution

Britain is becoming a more interesting place. Driven by various political and economic forces, the government has decided to experiment with devolution. Next week the people of Scotland will elect their first parliament for 300 years (p 1166) and those of Wales an assembly (p 1167). If the "peace process" continues in Northern Ireland it too will eventually have elections. Devolution is also under way in many other countries, and this theme issue on health in a devolving world considers Sweden (p 1156), Finland (p 1198), Canada (p 1201), and Spain (p 1204).

The health services in the four countries of the United Kingdom have been different ever since the NHS began in 1948, but they are now diverging rapidly (p 1195). The Scots are the most enthusiastic about devolution, and they are, for example, having a heated debate in their media that is simply not happening in England about the private finance initiative for building hospitals (p 1220). It has emerged as a central issue in the election. One exciting thing with devolution is not knowing where it will lead and end. If, predicts Colin Leys in an editorial, devolution causes resources to flow to more deprived areas, then poorer areas of England may become interested in devolution (p 1155). How will people feel when a major serviceperhaps long term care or assisted reproductionis available through the "National" Health Service on one side of a border but not the other? And will devolution culminate in Scotland becoming an independent state within the European Union?

A second exciting aspect of devolution is that more experiments are possible in the "health services laboratory" that is arguably a major asset of what's now the United Kingdom. An article examines, for example, how Scotland's local healthcare cooperatives are doing things differently from England's primary care groups (p 1185). The BMJ faces a challenge in keeping up with all this experimentation (p 1221), and I think out loud in an editorial about how we can avoid becoming the English Medical Journal (p 1158).

Another experiment begins this week at the BMJ: we are ready to receive email submissions from outside the UK (p 1184). Simply send your "paper" to papers{at}bmj.com. Why, UK authors may ask, can't we receive them from within Britain? It's because our internal systems are not yet up to the load, but we are heading towards a system where the whole process of submission and peer review will be electronic.

With so much that's new it's reassuring to turn back to what's old, and Dr A L Wyman has found us a marvellous quote from Tchekhov (p 1176). "Doctors have loathsome days and hours, such as I would not wish on my worst enemy ... but ...."

Footnotes

To receive Editor's choice by email each week subscribe via our website: www.bmj.com/cgi/customalert

---

© BMJ 1999
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Related Articles

Devolution in Latin America has had poor effects on health care

Peter Sandiford
BMJ 1999 319: 55. [Extract] [Full Text]

The NHS after devolution

Colin Leys
BMJ 1999 318: 1155-1156. [Extract] [Full Text] [PDF]

Devolution in Swedish health care

Finn Diderichsen
BMJ 1999 318: 1156-1157. [Extract] [Full Text] [PDF]

Avoiding becoming the English Medical Journal

Richard Smith
BMJ 1999 318: 1158-1159. [Extract] [Full Text] [PDF]

Measures to improve underfunding are central to Scottish election health policies
BMJ 1999 318: 1166. [Extract] [Full Text] [PDF]

Welsh Assembly candidates target inequalities in health
BMJ 1999 318: 1167. [Extract] [Full Text] [PDF]

Towards primary care groups The development of local healthcare cooperatives in Scotland

Jane Hopton and David Heaney
BMJ 1999 318: 1185-1187. [Full Text] [PDF]

Devolution and health: challenges for Scotland and Wales

Allyson M Pollock
BMJ 1999 318: 1195-1198. [Extract] [Full Text] [PDF]

Decentralisation and equity of healthcare provision in Finland

Meri Koivusalo
BMJ 1999 318: 1198-1200. [Extract] [Full Text] [PDF]

Decentralised health care in Canada

Pat Armstrong and Hugh Armstrong
BMJ 1999 318: 1201-1204. [Extract] [Full Text] [PDF]

Devolving health services to Spain's autonomous regions

Diego Reverte-Cejudo and Marciano Sánchez-Bayle
BMJ 1999 318: 1204-1205. [Extract] [Full Text] [PDF]

Media: Scottish fears over PFI

Bryan Christie
BMJ 1999 318: 1220. [Full Text]

BMJ should stop confusing its readers over national differences

Arthur Morris
BMJ 1999 318: 1221. [Full Text]

Rapid Responses:

Read all Rapid Responses

Reply to Editor's Choice

P P McKeown
bmj.com, 5 May 1999 [Full text]