Intended for healthcare professionals

Education And Debate

Devolution and health: challenges for Scotland and Wales

BMJ 1999; 318 doi: (Published 01 May 1999) Cite this as: BMJ 1999;318:1195
  1. Allyson M Pollock, professor
  1. Health Policy and Health Services Research Unit, School of Public Policy, University College London, London WC1 9EZ

    Editorials by Leys and Diderichsen

    Allyson Pollock is guest editor of this week's devolution issue

    On 6 May Scotland and Wales will elect their new assemblies. Will they have sufficient powers and sufficient finance to reverse the existing and widening inequalities in health in the United Kingdom? Will they adopt new approaches to health policy and a new focus on public health?

    Summary points

    The new assemblies for Scotland and Wales face major challenges tackling socioeconomic and health inequalities

    Primary legislation for Wales will be made in Westminster. Scotland will have primary legislative powers over the departments it controls

    The new assemblies will be financially dependant on Westminster through the Scottish and Welsh “blocks.” Planned changes in expenditure for England are allocated to Scotland and Wales through the Barnett formula, a population based formula rather than a needs based formula

    Wales will have no tax varying powers. Scotland will have the power to vary income tax by 3p in the pound, the so called “tartan tax”

    The challenge for the United Kingdom is how to improve inequalities in health and wealth and preserve equity in funding through the devolved assemblies

    The structure of the new assemblies and their powers

    The Scottish parliament will serve a population of five million and have a Scottish executive of about 10 ministers headed by a first minister. Its departments will include health; education and training; local government, social work, and housing; economic development and transport; the law and home affairs; the environment; agriculture and fisheries; sports and art; and research and statistics (see box). The UK parliament will retain control over the constitution, foreign policy and defence, social security, employment, and the fiscal economic and monetary system. The Scottish parliament will hold fixed term elections every four years and have 129 members, 73 elected from single member constituencies plus 56 additional members to provide proportionality. …

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