Devolution and the Scottish NHS

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7098.1848 (Published 28 June 1997) Cite this as: BMJ 1997;314:1848

Scotland's needs may be better addressed after devolution

  1. Colin Currie, Senior lecturer in geriatric medicinea,
  2. Anthony Toft, Consultant physicianb
  1. a University of Edinburgh Medical School, EH8 9AG
  2. b Royal Infirmary of Edinburgh, EH3 9YW

    Scotland, with a population of five million people, is in that respect comparable to an English health region. Thereafter, similarities fade. Responsibilities for the NHS in Scotland lie, not with a regional authority, but directly with a Scottish Office minister and his civil servants in St Andrew's House, Edinburgh. Per capita spending on health is higher in Scotland than in England, yet many health indicators remain obstinately worse. And even the history of the NHS in Scotland is different; a separate piece of legislation–the National Health Service (Scotland) Act 1947–established different procedures for appointing consultants and greater participation by universities in the running of the service, and sought to ensure that “the special virtues of the Highlands and Islands Medical Service would be protected and extended to the nation as a whole.”1

    More recent reforms, seen as driven by the problems and politics of England, have been generally less admired. Market led and quango based solutions, …

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