Letters Health care and devolution

Full of sound and fury, signifying nothing

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c779 (Published 08 February 2010) Cite this as: BMJ 2010;340:c779
  1. Stephen McCabe, principal general practitioner1
  1. 1Portree Medical Centre, Portree, Isle of Skye IV51 9PE
  1. steveborve{at}hotmail.com

    Perhaps because I work in the north of Scotland, I am fond of quoting Macbeth, finding “full of sound and fury, signifying nothing” an apt description of the Nuffield Trust’s report on the effect of devolution on health care.1

    What “tale” is the report trying to tell? More importantly why doesn’t it focus on the possible reasons for the differences? As Donnelly points out,1 Scotland was right up at the top when it came to practising evidence based care and achieving patient satisfaction. Why? And is it not something that the NHS in England should aspire to?

    But other issues seem to have been largely ignored by the Nuffield Trust. Perhaps the most obvious so far as the high cost of health care in Scotland is concerned are remoteness and rurality.

    The provision of two general practitioners plus their necessary surgery staff plus associated community health staff plus ambulances plus out of hours care, and so on, to a small, isolated community of only a few hundred souls is very, very expensive. But it’s also very, very necessary if we are to uphold the founding NHS principle of equality of access to good primary care.

    If you try to compare chalk with cheese you are seldom going to come up with a satisfactory answer.


    Cite this as: BMJ 2010;340:c779


    • Competing interests: None declared.


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