Editor's Choice

B is for British

BMJ 2006; 333 doi: http://dx.doi.org/10.1136/bmj.333.7559.0-f (Published 13 July 2006) Cite this as: BMJ 2006;333:0-f
  1. Fiona Godlee, editor (fgodlee{at}bmj.com)

    It's traditional at the BMJ to worry about the B. It stands for British in case you didn't know. On the one hand we are very proud of it but sometimes it seems to stand between us and our international aspirations. A few years ago our editorial board seriously discussed changing the name to the Global or the World Medical Journal. Nothing happened so I guess the decision was no.

    Now I have a new worry. Have we become the English Medical Journal? So much of our coverage is about England, so little about the other parts of the UK. In the past month we ran four editorials and 19 news stories on the NHS. All except one were about the NHS in England. Perhaps there is nothing going on elsewhere in the UK, but I don't think so. I think we have defaulted to the same biases that afflict the UK government. A BMA briefing paper on UK devolution calls it “operating on an English-only basis” (www.bma.org.uk/ap.nsf/Content/ARM2006devolution).

    The paper is worth reading for an update on the implications of devolution for health policy across the UK. Briefly, the creation of national assemblies for Wales and Northern Ireland and a parliament for Scotland has given political autonomy across a range of healthcare issues. But the UK's House of Commons and its health select committee are primarily focused on England, and devolution has hardly impinged on English consciousness. This was clear at the last general election, when Tony Blair illustrated his government's achievements by comparing waiting times in England with those in Wales.

    I don't know whether readers in other parts of the UK take these biases in their stride, gnash their teeth, or have given up reading the BMJ because of them. One doctor in Wales told me that he is used to the assumption that primary care trusts and practice based commissioning exist in Wales and Scotland as well. For the absence of doubt, they do not.

    Other comparisons with England are illuminating. In Wales, says the paper, the emphasis is on tackling the causes of ill health rather than on managing the health system. Wales has retained community health councils and gone for free breakfasts for primary school children and free prescriptions for all. Scotland has reconfigured services but with broad support from the profession and the public. Northern Ireland has undergone only limited health system reform since its assembly was suspended. Overall, there is less appetite for market oriented solutions, more small scale piloting and evolution, and more consultation.

    The UK government is frustrated at the lack of reform in the devolved nations. But what's really happening is reform of a different kind. Devolution has created a natural experiment, with different approaches to healthcare policy and provision—even though one effect has been to make the collection of comparable data harder (bmj.com/cgi/content/full/331/7522/946). We could all do more to celebrate these differences and learn from them.

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