The NHS after devolutionBMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7192.1155 (Published 01 May 1999) Cite this as: BMJ 1999;318:1155
Will have an even sharper focus on health inequalities
- Colin Leys, Visiting professor
- School of Public Policy, University College London, London WC1H 9EZ (and emeritus professor of politics, Queen's University, Kingston, Canada)
Editorial p 1156 Education and debate pp 1195 −1205 News p 1166 Personal view p 1221
Health and personal social services will be the biggest responsibility of the new Scottish Parliament and Welsh Assembly to be elected on 6 May, accounting for over a third of the total spending under their control.1 What are the likely implications for the future of the NHS? How far will devolution affect its core principles of comprehensiveness, universality, and free service at the point of provision? What, especially, is likely to be the impact on the principle of equal care for equal need?
Even in federal systems, where the powers allocated to provincial, state, or regional governments are protected by written constitutions, the central government's superior revenue base usually allows it to secure a large measure of uniformity in return for transfers from the federal budget, as the case of Canada illustrates (p 1201).2 The Canadian constitution makes health a provincial responsibility, but, despite provincial variations in the way health services are delivered, the federal government's substantial share in financing them means that all Canadians get the same free access to family doctors and to a nationally determined range of hospital services, regardless of their province. Where powers are merely devolved, with little or no tax raising authority, as in the new British …