Since I cannot get the political parties to discuss philosophy, and since I agree with Matthew Parris that we have one hell of a taboo area in discussing health honestly, I thought I would try to answer my own question. I have thought of 10 areas… but please let me know of others… (I don’t really mind about privatisation as long as education and the long term perspective is covered – it is usually not covered adequately)
What is National About the Health Services in the UK?
1. We all pay tax under the same fiscal rules and system. However this might well change with Scotland demanding tax-raising powers, and doubtless Wales will follow eventually.
2. We generally live by the same laws – lack of an “assisted dying” law is universal, but even within the law there are differences. My Kidney is an “opted in by default” kidney, whereas readers in England still have to carry a card, and are opted out unless they do so. Theoretically Wales should provide pro-rata many more kidneys..
3. If a service is not available in one part of the UK, a patient can apply for funding as an OAT (Out of Area Transfer), but may be refused. The length of time, and the bureaucratic hurdles to jump mean that many applications are rejected, or the patient goes privately…. Life saving treatments such as cardiac surgery are an exception at present. On the other hand, prostate cancer treatments vary greatly by region and post code, and since there is a service here in Wales I would be refused an OAT. A new radiotherapy treatment had to be funded by charitable donation….
4. We are all allowed a second opinion. In my region we have to get that second opinion in our own trust if there is another consultant who can provide it. This could be different in England, depending on the trust concerned. The fact that in Wales the patient is seeing someone with the same mind set and work based experience does not seem to influence the decision makers.
5. The CHC (Community Health Council) is still funded in Wales (Not in England) but it’s staff are subject to government dictate, and speaking out is not encouraged. I have written elsewhere on this, and suggested 10 year funding trickle fed through a third party… CHCs exist across Wales but their influence is marginal.
6. Staff sickness and absenteeism is universally bad. (As is morale)
7. Salaries and Wages are much the same, but a London weighting gives a cursory extra to those working in the Greater London Area.
8. Education. All regions have Medical Schools. Not all Medical Schools take the same exams. Scotland overproduces doctors, whilst Wales underproduces. All over the UK, every year, a significant number of applicants who have the potential to be doctor are rejected, usually males, as females perform better at age 18.
9. Prescriptions are free for children, the unemployed and disabled, and the elderly. This is in all regions, but Wales and Scotland have comprehensive free prescriptions.
10. Accident and emergency attendance is free throughout the UK. The parking however is not free, but it is in Wales.
11. Waiting. We all wait, in A&E, GP practices, for appointments, for operations. but as in Animal Farm, “some are more equal than others”, and wait less.
12. Choice. A reminder: Choice is limited to your own trust in Wales, and Scotland, but “Choose and Book” applies across England only. This is why NHSreality has suggested a minimum number of Trusts in Wales… we could get away with two.
There is no NHS – a parody poem by Roger Burns – The NHS 2018