The SNP have criticised English health, but do their attacks stack up?

Elliot Bidgood, 3 December 2013

‘Scotland’s Future’ white paper announced with fanfare last week stressed Scotland’s devolved NHS, seeking to strike contrasts with Westminster’s handling of the English service. This follows remarks in October by Scottish health secretary Alex Neil, in which he attacked the present English reorganisation, privatisation, NHS 111 and prescription fees. This is all part of the SNP strategy for the 2014 referendum, though since the above are all England-only issues and a vote for independence would “not affect the day-to-day management of the NHS in Scotland” as the SNP government correctly state, its practical relevance is unclear.

Nevertheless, healthcare differences between England and Scotland are always an interesting topic, as I noted in June. Civitas explored the topic in-depth in 2004, in August I noted that the English NHS was better at reducing missed appointments and in July, I noted that target-related manipulations of waiting times had occurred in two Scottish NHS trusts.

The latest annual Euro Health Consumer Index, released on Thursday, also split Scotland from England and Wales for the first time (though Wales also has a devolved service and Northern Ireland isn’t clearly mentioned, raising methodological issues). Scotland performed one point better (719/1000, to 718 for “England”) on the basis of access to medical records, lower elective surgery waits and fewer infant and heart attack deaths. However, online appointment booking, kidney transplants and at-home dialysis were more available in England. Prevention was also better, including for alcohol-related conditions, and a separate study reported today suggested that alcohol-related deaths were 47% higher in central Scotland than in northwest England.

Lessons need to be learned from this year’s reorganisation and NHS 111. SNP criticisms of English prescription fees also have some basis, as evidence suggests fees can still inhibit access and may require restructuring (it remains to be seen if Scotland’s free prescriptions are fiscally sustainable long-term, though). On market-like reforms, however, the SNP is dead wrong. Scotland’s NHS still largely operates as the English NHS did before 1990, without most of the trappings of the internal market. But Professor Nicholas Mays of the London School of Hygiene & Tropical Medicine noted that hospital mortality has fallen faster in the reformed English NHS than in Scotland (despite Scottish per-head spending on health being higher), while Dr Zack Cooper’s studies in England have also suggested that hospital competition saves lives. Further, the amount the Scottish NHS spent on private treatment (to combat rising waiting times) actually increased by 60% in the past year, highlighting the emptiness of the SNP’s “anti-privatisation” rhetoric.

The NHS being split into four devolved services brings benefits in terms of accountability and the potential for cross-learning. But while there are certainly things England can learn from Scotland, Scotland has its issues, and it may prove unwise for Scotland to reject competition as a means to strengthen services for patients, as England has done with some success.

For more of our work on health, including books and research papers, visit our website here.