Tuesday, January 19, 2010

Is It Really a NATIONAL Health Service?

I'm not sure we should continue calling the NHS a NATIONAL Health Service when it is patently nothing of the sort. The Telegraph has a front page story abot how NICE are preventing English patients from receiving an arthritis drug which is freely available in Scotland and Wales.

I fully recognise that the NHS can't meet every demand made on it, but this example is but one of many. We never hear examples of drugs which are available in England but not Scotland and/or Wales.

Do readers haveany examples?


brian said...

It's always worth posting this analogy when the subject of difference between England and Scotland arises. Feel free to copy this elsewhere.:

Dear English Football Association

As a representative of the Scottish Football Association, I would like to inform you that we wish to change the way the English Football team is managed to bring it more in line with the way our Prime Minister, Gordon Brown, is running Britain.

This will involve the following:

1. The Manager of the Scottish team is allowed to be involved with the running of the English team. However, the manager of the English team should have no say whatsoever in the running of the Scottish team. This shall be known as the West Lothian Question.

2. A sizable proportion of any money the English Football Association raises from, say sponsorship or crowd takings, shall be given to the Scottish Football Association, regardless as to whether you need it or not. This does not apply the other way round. This is known as the Barnett Formula.

3. You are not to call yourself England any longer. You will now be known as the British Regions. We, on the other hand, are still to be known as Scotland, “a proud and noble nation”.

4. Medical treatment to your players will be limited to a few treatments because of cost. No such stringent limitation applies to Scotland.

5. If your playing surfaces are flooded, then do not expect much assistance. However, Scottish pitches will be adequately provided for in the event of flooding.

6. From this moment on, the English Football Association will cease to exist. However, the Scottish Football Association will be allowed to continue to work independently.

A failure to follow these rules will see you branded as arrogant, selfish and unfair.

I’m sure you will find this to your satisfaction. After all, you seem to be happy with this state of affairs with your political system, so why not your Football team?

Yours sincerely

Mr G Brown.

PS You English are so na├»ve, you are being abolished and don’t even realise it.


Twig said...

The English are second class citizens in Labour's version of apartheid.

IanVisits said...

On one hand, we want less centralisation and more decisions taken at a local level.

On the other hand we decry the post-code lottery and the lack of a centralised uniform service.

How can these two demands be reconciled?

Mark Pasola said...

Probably due to the Barnett formula don't you think Iain.

English voters get to pay for drugs in Scotland but can't afford them for themselves.

Anonymous said...

Don't be daft, Iain; of course, there are no examples.

Perhaps you could let some of your chums at Conservative Party HQ know that the NHS they're campaigning about is the English NHS. There's no such thing as the British NHS any more, as the NHS('s) are separately run by the devolved administrations and the (English) Department of Health respectively.

Try telling that to the writers of the Tories' draft manifesto on the NHS two weeks ago: not a single mention of England throughout the document, even though it applies to England only .

David Boothroyd said...

If you're in England and you're sadly diagnosed with cancer, you get free prescriptions. If you're in Scotland and you're sadly diagnosed with cancer, you are not exempt from paying for prescription charges.

It's perhaps worth noting that had the Conservative model for the NHS prevailed in the 1940s, there would have been complete local autonomy about prescribing, with NHS services being delivered by voluntary and local authority hospitals rather than institutions owned by the NHS itself.

Anonymous said...

NICE has nothing to do with clinical excellence (and clearly it too is not national). Its a typical new labour ploy to ration health care.

Because English taxpayers subsidise Scotland the Scottish 'parliament' can chose to spend money like this. Salmonds objective of course is to pi$$ off the English since there is no majority for independence in Scotland itself.

Gareth said...


Did you read David Cameron's Draft manifesto on the NHS.

It should really be called the Draft Manifesto on the English NHS because it's all about England and has nothing to do with NHS Scotland, NHS Wales or NHS Northern Ireland.

However, despite this fact, Dave managed to get through the entire thing without mentioning the word 'England' once. He mentioned 'Britain' and 'our country' and 'this country' but not England.

The question is, why?

It's an artifice to deceive. They want us to belive in the 'British NHS' but in reality there is no such thing.

Labour are no better either. Alan Johnson and Gordon Broon managed to present the NHS Constitution as something 'British', hailing it as a great day for 'our country'. When in fact, as the Lords explanatory note tells us, "The Constitution is for the NHS in England only."

David Starkey claimed that England was the country that dare not speak its name. He was wrong. It's only our British-mongering politicians who dare not speak England's name.

Salmondnet said...

Short answer, no it isn't, but then the Scottish and Welsh votes on devolution exposed the idea that Britain is a nation as a fiction. The only thing that keeps Scotland in the Union is the £1500 or so per head more than England it receives under the Barnet Formula, which enables the Scottish Government to provide benefits which the English do not enjoy.

The remedy is simple, demand an English Parliament, either within or without the Union.

Unknown said...

Gordon Brown is a pain and he's only available in England. Does that count?

richard.blogger said...

Iain, here's a clue: health is devolved, so Wales, Scotland and NI control their own system. More worrying is the $3 billion of privatisation announced in the Tory Green paper on public health. http://bit.ly/7NaJb3

Twig said...

@Ian Visits...
On one hand, we want less centralisation and more decisions taken at a local level.
On the other hand we decry the post-code lottery and the lack of a centralised uniform service.
How can these two demands be reconciled?

By having Local Insurance Contributions instead of "National" Insurance Contributions?

Jason Lloyd said...

there is a set budget spent on health in Scotland. Cancer drugs being available on the formulary is good, fewer nurses in wards etc is bad. local budget = local choices. Difficult decisions are being made in the NHS all the time. We could just increase taxes to This is not a Scottish vs English thing, but your headline and some of the comments demonstrate why the conservatives are doing so badly in Scotland. You just don't get it.

Jonathan Sheppard said...

Ian - you of course know of free prescriptions which the Welsh got but you didnt in England. I agree with an earlier comment. If decisions in health are taken locally which is what is advocated then you get a different level of health provision from area to area.

One PCT will offer something that another willnot. Am I right in thinking IVF treatment varies from area to area about how many treatments you can get? If so I would assume there will be widely differing treatments in other medical areas.

Cynic said...

Its partly about the BArenett formula and local accountability. Voters want more of everything while it seems free but once hard choices have to be made its better that they are made and explained locally.

Also it may well be that the NHS in the Regions is smaller and can therefore run with lower overheads - the DoH is a monster that justifies its existence by setting and monitoring standards heedless of the costs of collecting all the often meaningless crap that Senior Officials and Ministers so love

Anonymous said...

On one hand, we want less centralisation and more decisions taken at a local level.

On the other hand we decry the post-code lottery and the lack of a centralised uniform service.

How can these two demands be reconciled?"

You can go a long way to sorting the problem by setting a minimum level of care - a "Patient's Charter", if you like.

How the local authority funds it, is their responsibility.

By distancing central Govt, local authorities will be able to concentrate on providing services, not filling non-jobs forced on them by central Govt.

A total equality will never be achieved. The current Govt exercises Marxist levels of control and STILL has a post-code lottery. That, I believe, is largely due to the excessive levels of bureaucracy, enforced by central Govt.

Apart from which, different areas of England face different problems. Those with heavy industry have a different composition of illness to rural areas, so different skills are required.

Personally, I'd introduce private healthcare wards into NHS hospitals - let the private patients help finance the NHS patients.

Tuechter said...

Calm down Iain there has been a seperate Scottish Health Service since the inception of the National Health Service in the 40s. It was under the aegis of the old Scottish Home and Health Dept (which also ran the police, prisons etc). This reported to the Secretary of State for Scotland. Post devolution its the Minister for Health in the Scottish Executive - no conspiracy!

Michele said...

Graeme - unfortunately we do get it;

the budget you spend is financed partly by the Barnett Formula which apportions monies by nation rather than need.

The need is long gone, as even its creator acknowledges; it is as the Tories admitted 'the price England pays for the Union'

It is too high a price for more and more of us to accept.

Unknown said...

Other countries manage a good health service, Canada for one. Then again I have not been back for 8 years now so I am sure it is having its problems.

The problem here is, Education, we have created two generations of Jobs Worth who stick to the point, and cross the T's and that is that.

It does all stem from poor education, other wise why would you get all the insane health and safety rules that you get now?

Not the lawyers, because a smart person says you have to watch out and take responsibility for what you do.

Bob said...

Is it not that only the not pregnant working population of England that pays for preseciption charges?

Wyrdtimes said...

graeme. We get it all right.

England is getting the Brown end of the stick in all areas - and the Tories are going to do nothing about it.

Anyone speaking out for England is branded a "sour little Englander" by Dave "proud of my Scottish blood" Cameron.

When will the English wake up?

Home rule for England.

Mark M said...

And yet some people continue to disagree when you suggest that NICE is a death panel. #welovethenhs? I suspect a whole bunch of people with arthritis suddenly decided that they don't.

Benny said...

Could we have more academic answers please. I've got to do an essay on this very qestion in 5 weeks. Thanks.

Drew said...

Labour and Conservatives both seek to decieve when it comes to the NHS and England.

They want to convince us in England that there is still "one UK", ruled by one government.

Health apartheid? The politicians don't seem to care. As Mr Cameron says, better an imperfect "Union" than a broken one.

I don't understand it at all.

Drew said...

graeme: you seem to be missing the point that more is spent on the NHS in Scotland via the Barnett Formula. There are complex issues here, many of us would like them addressing. And I'm not a natural Conservative. I used to be a Labour supporter - until that party became something entirely different.

Anonymous said...

Scotland is a socialist country. Has been for years. Public service there is heavy. Enterprising Scots move down South.

Scots would not vote for independence as long as us the English finance them. If we talk about the Barnet formula, the " oil cliche" surfaces.
The following points:
- West Lothian question. English universities fee and NHS related acts were pushed through on the back of Scottish MPs who have no say in their constituencies. They are voting fodder for Labour. If this isaid Scots cry about Poll tax which was longer lasting. Wait until Salmond brings the local income tax/taxes them using the new powers given to them.
- Scottish Higer students (they pass As level and not A2 as in English A levels) come and join English universities and can study for 3 years in UG course, pay no fees. English A level students have to study 4 years in Scotland unless they get AAA ( 360 UCAS points) when they can join year 2 of Scottish UG course. They have to pay fees
- English universities have more Scottish students ever before and their Scottish Higher result coming out 2 weeks before English A level sresults means, English students have disadvantages when it comes to 'clearing'
-Scots want more immigration , Salmond does, as Bright Scots move South. These immigrants will end up in England. Also Scottish overseas students do move South after graduation. Not many know this.
- We are lumbered with Scottidh Cabinet ministers, Gordo and Gorbals Mick.

Barbazenzero said...

You really have little understanding of what a "Nation" is, Mr Dale. Whatever the UK is, it is not one Nation but four - or arguably 3½ - in a single, semi-democratic state.

You would be right to rail against NuLab's caghanded asymmetric devolution but rather the complaining about it you would be better either arguing for a democratic English parliament (perhaps best located in the old capital, Winchester) or taking UKIP's view and abolishing it entirely - a courageous view in the light of recent polling that both Scots and Welsh want more powers for Cardiff and Holyrood, if not yet outright independence.

hafod said...

"We never hear examples of drugs which are available in England but not Scotland and/or Wales."

Had you done an iota of research before posting this, you would know that treatment freely available in England (e.g. http://www.southwalesargus.co.uk/news/4440333.Newport_man_loses_out_in_cancer_postcode_lottery/) are not available in Wales. Rows over breast cancer drug herceptin have also been highlighted in the recent past.
This has caused equal amounts of outrage on the Welsh side of the border but didn't register because (a) it wasn't in the Telegraph and
(b) it doesn't fit the narrative of poor old England being discriminated by those beastly Celts.

As Graeme has explained, the point of devolution is that some things will be done differently. I thought the Tories were against centralisation!

Anonymous said...


Local budgets? The labour govt have consistently reduced the budget for my local NHS in Oxfordshire (no doubt because there are no marginals where I live)

So my budget is as local as the one in Glasgow or Dundee. Control of Dundee's budget has been given to a devolved parliament, which is in turn subsidised by English taxpayers.

Nothing intrinsically local there. If Scotland want to have different healthcare, then let them pay for it. Devolution is a half baked sham.

Anonymous said...

There are plenty of areas in which the Welsh health service is second class to the English service.

Our stroke care is shocking, with far less specialist units than in England.

Ambulance waiting times are very high in some areas, and that doesn't just mean rural areas.

You can't get three cycles of IVF anywhere on the NHS in Wales, where in some parts of England you can.

There are over £200 million 'high and serious risk' repairs needed to our hospitals, because the government hate using private cash.

But on the other hand, we have free prescriptions and free parking. Both of which are bloody awful ideas and a waste of money.

There have been good decisions, such as not spending nearly as much money on a wasteful IT system.

The point is, there are plenty of areas where England is better than Wales, and some where Wales is better than England. That is the point of devolution. Our government has taken different decisions and has therefore achieved different results, some I agree with, some I don't.

The problem is that the English media only ever choose to highlight those things which are better in Wales, and rarely will the tabloids present a balanced debate along the lines of "In England, you pay £7 for anti-biotics, but you're more likely to survive a stroke".

There needs to be some form of responsibility from the media here, who just seem hellbent on convincing people who live in England that they are victims of some giant conspiracy. It's anything but!

Number 7 said...

OT - It appears that McBruin's new policy of being nice to the middle classes is only until the election.

HMRC are recruiting:-


Big rise in Council Tax anyone?

John said...

"Is it really a national health service ?"

Rather surprised you are even asking this Iain. Perhaps you have been too closely locked up in the remote fastnesses of Tory Central. Time to come out and connect with English reality.
Even the Telegraph has belatedly cottoned on to this- see today's front page.

Despite dogged Tory attempts to deny England exists
(all we ever get Britain, Britain, bloody Britain-----they hate even saying the word England, see the recent announcement on the English NHS which tried to kid everyone it was about Cameron's "Bri'ain". Doubtless the dozy Tory MP's fell for it and - some of- their support workers)

-England does in fact exist and has its own NHS now totally separate from the other three NHS's of Wales, Northern Ireland and Scotland. Health has been a devolved subject since the passage of the Scotland Act 1998. The NHS's of those countries are almost completely under the control of their respective parliaments and assemblies.

You have probably registered that there is massive and semi secret discrimination in funding perhead perannum by the British government on a bald national basis(Barnet rules). There is no attempt to justify this on a basis of need and never has been. Just straightforward discrimination against the English and thats it.Typically British.

ie Scotland gets at least £1450 perhead perannum more from the British government than the english do and this incldes health.

(completely contrary to the mores of the 0UN Charter of which the British government is a signatory )

It is not only funding . Organisation of health is now very differnt in England than in Wales and Scotland. In England there are PCT's and Primary Care Groups . Not so elsewhere.

NICE, by the way used to apply to England and Wales, now mainly only to England.

Anonymous said...

The Tories should be much further ahead in the polls than they are. They are not further ahead because of Cameron's pathetic leadership and his failure to address the disadvantages heaped upon the English compared to his beloved Scots.

Instead he prefers wasting valuable time during PMQs repeating the same old (but failed) tactic of point-scoring against Brown by repeatedly banging on about boom and bust.

I want to hear more questions from the Tories about the virtual apartheid perpetrated against the English at all levels, not only in healthcare. Afterall, the Tories would not exist in Westminster if it were not for English votes.

Instead Cameron goes up to Scotland promising more powers for the Scottish Parliament. Also, we see a plethora of Scottish Tory candidates in England who would not have a prayer of winning in their own country.

I'll not be voting for the Scot the Tories have presented me with because the Tories have systematically failed the English at every given opportunity since devolution.

Cameron has even backed two-year degrees in England, but has not suggested a reduction in the four-year degrees in Scotland. So we are to see our degrees devalued while the bonnie Scots continue to have theirs maintained through English taxpayers' largesse.

Should the Tories get in at the next general election and Gordon Brown keeps his seat in Scotland, Brown will still have a say on the English Health Service by voting at the third stage of any Bill pertaining to it.

No thanks.

Stephen Gash said...

David Boothroyd said...
If you're in England and you're sadly diagnosed with cancer, you get free prescriptions. If you're in Scotland and you're sadly diagnosed with cancer, you are not exempt from paying for prescription charges.

You are on very dodgy ground there. About 15 cancer drugs are available to Scots that are denied to the English. So it is pain-killers that English cancer patients get for free, not cancer drugs. Scots pay lower prescription charges than the English, which will eventually move to zero, as in Wales.

Add to that the bowel cancer screening programme available to Scots aged 50-74, but to the English aged 60-69 as well as other significant benefits in other cancer screening, I think it is fair to say the Scots come off far better than the English regarding cancer healthcare.

bnzss said...

It's hardly a health service in the first place.

Wrinkled Weasel said...

Dear Boothroyd - so factual, so authoritative, so obsessive and...

so utterly out of context. He is talking about 74,000 people, out of a population of 60 million.


Poor Scottish people already get free prescriptions. So cancer patients who fall below a certain threshold not pay. Indeed, very few do pay, those that remain are at the mercy of other parties:

"We remain opposed to any further moves to reduce prescription charges for the 7 per cent that still attract any cost." (Annabel Goldie)

The move to abolishing charges altogether in Scotland was proposed at the beginning of the administration has been perpetually blocked by the Tories and other parties. The SNP have already reduced charges to all, and have continued to provide free eye tests.

The cancer issue is a one-off, and is riddled with caveats, largely dependendent on NICE and local health authorities to include the treatment under the exemption. It has only been available since last April.

On the whole, Scottish patients have less to pay overall.

Altogether, the muddled thinking over this issue is a paradigm of how the opposition parties oppose good ideas on principle, simply because they had not thought of them.

It is also an example of how England will be left behind, a third world country with an impoverished working class.

Here is a good source of the information:


Anonymous said...

@ graeme

With all due respect it is you who doesn't get it.

Either we are in a Union or we are not. Instead of a Scottish Parliament the Scots should have been presented with a referendum on Scottish Regions, Highlands, Lowlands and Islands for example.

Then they could have had regional Assemblies, then Regional Grand Committees foisted on them even though they voted against such bodies.

Scottish public services, including healthcare, could have been regionalised.

Pre-devolution we were all in the same boat. It is highly improbable that Thatcher would have permitted cancer drugs to be denied the Scots while available to the English. It is even more improbable that she would have even contemplated Scotttish students being the only ones in the whole of the EU to pay top-up fees when attending English Universities. However, we English are expected to accept the reverse "for the sake of the Union".

Before you write "what about the poll tax?" phone up Malcolm Rifkind to find out the truth about why it was introduced in Scotland first.

The truth is, what could have been a fair tax, if introduced gradually as planned, was completely screwed up by Scottish politicians pleading for it to be rushed in to stave off a hike in Scottish rates.

The Tories won't do as well as they anticipate in England because they say nothing about the inequities the English endure. As has been pointed out Dave (I've got lots of Scottish blood in my veins) Cameron could not even bring himself to mention England in a document dealing only with England.

Every English person either is, or knows someone, paying top-up fees, who has sold their home to pay for social care, who has been denied cancer drugs, etc etc. After ten years such things are impossible to hide. Yet Cameron and the rest of the Tories, when lifting up their heads from the expenses claims, still bang on about "our country" "the NHS" "the education system". This no longer works.

They will pay at the ballot box because people will vote for anyone, but the three main parties.

Anne said...

Abortion and Northern Ireland. Women there must pay for an abortion under the NHS while still paying National Insurance.

Anonymous said...

@ hafod

The article seems to be saying that the patient is being denied payment for accommodation, not the medicines.

There was a similar case reported on a particular deceitful Channel4 documentary a couple of years ago about a cancer patient in Wales being deied treatment available just across the border in England.

However, this treatment was provided only in one English Primary Care Trust which just happened to border the Welsh county this particular patient lived in. If the PCT had been in Lincolnshire it would have been a non-story. However, Channel4 reported the exception that proved the rule in an effort to hide the international, intra-UK healthcare lottery.

The Welsh are whining that Welsh patients are being denied treatment in England because the Welsh Health Service has failed to pay for treatment of previous patients. They are also whining that they are not getting to the top of the (supposedly) shorter waiting lists. So, it would appear that the Welsh want to get the benefits of shorter waiting lists and to receive treatment paid for by the English, not only via the Barnett Formula, but also out of their own Health Service's budgets.

Devolution has shown that the "fairness" Gordon Brown bangs on about is not a British characteristic, but an English one.

hafod said...

Welsh school pupils get, per head, £500 per annum, less spent on them than their English counterparts. Barnett institutionalises the differential, no matter what the Welsh Assembly Government wants to do.
I defy anyone to claim that the funding formula under Barnett favours Wales.

Unknown said...

Iain, RoActemra is available in England - it is a licensed medicine. It's just that the NHS in England will not pay for it and why? Because it is far too expensive for the good that it does. Why do you never turn your fire on the real reason for this? If Roche want it to be used in England and so boost their profits they know perfectly well what to do - reduce the price to one that is acceptable.

Independent England said...

England will only be free of these injustices when it is free of the UK.


Jason Lloyd said...

in reply

I don't think the Barnett formula is fair or works today. It should be flexible to adjust for population changes and means tested. I don't agree that Scottish MP's should vote on English health matters(west lothian Q)

I do think that Iain's post was sensationalist in stirring these two (very important) factors by the wording of his post. This is essentially a question of localised decision making against centralised control.

My heart say local, but my head keeps coming up with these injustices so says central.

Perhaps we should introduce ELECTED cheif executives for each Primary Care Trust to give local accountability. Elections on the same day as the Polive Commanders?

Terry Heath said...

Someone said "This is essentially a question of localised decision making against centralised control.

No it's not. It is about the Barnett Formula giving 20% more money to the UK's most wealthy nation, who in turn spend 25% more on Health than is spent in England.

Meanwhile in England, the PM and Chancellor are not only unaccountable to a single voter, when it comes to the English NHS: they have also signed a solemn oath to hold Scotland's interests "paramount" in all their "actions and deeds".

Why is this not a scandal, and why won't the Tories do anything about it?

Terry Heath said...

Hafod said “” I defy anyone to claim that the funding formula under Barnett favours Wales.”

I’ll defy you.

According to HM Treasury* Wales gets 13% more money, per head in real terms. Not as much as N. Ireland’s 30%, or the Prime Minister’s Scotland 21%.... but Barnett favours Wales in comparison to England.

England get the Brown end of the stick, again, as usual!

* http://www.hm-treasury.gov.uk/pespub_pesa08.htm
Chapter 8, Figure 9.4 “Total identifiable expenditure on services by country and region per head in real terms(1), 2002–03 to 2007–08”

John Bull said...

You're all overlooking Scotland’s real purpose, which is to maintain the myth of British world power, and to keep London in the style to which it is accustomed...

Scotland subsidizes England/ Britain - just because Westminster says that the Scots get more per head of population doesn't mean it's true. It's just to make the Scots think that, so they won't go for Independence...

Barnett is worked out on a small sliver of the pie. The majority of the money raised around the UK is spend in England (particularly the South East). If the Scots leave the Union, Britain will be in the toilet - no more Empire-centric mentality...

This is a good read: http://tinyurl.com/ya5rm9k

Terry Heath said...

”Scotland subsidizes England/ Britain …The majority of the money raised around the UK is spend in England (particularly the South East). If the Scots leave the Union, Britain will be in the toilet…”


Salmondnet said...

John Bull: The Taxpayers Alliance disagrees: http://tpa.typepad.com/home/files/unequal_shares_the_barnett_formula.pdf

Terry Heath said...

An excellent link, thank you very much, you should read it too.

It clearly states that England is subsidising Scotland...
”...such spending gaps are impossible to justify to English taxpayers. They ask why they should subsidise higher Scottish, Welsh, and Irish spending?”

It takes into account supposed “Scottish Oil”…
”North Sea revenues would not have funded the whole of Scotland’s additional public spending. The cumulative total over the whole period is a Scottish deficit of £26 billion.”

Interestingly, this is written before the English taxpayer had to bail out two Scottish Banks, so the situation is even worse than is painted here.

Finally it concludes…
”Clearly nobody wants to “upset the Scots”, but even those on the receiving end of the largesse aren’t always happy.” …that’ll be you.

Salmondnet said...

Terry Heath. You are jumping to (erroneous)conclusions. I am not on the receiving end and entirely agree with you. That is why I posted the link.

Terry Heath said...

D'oh, sorry Salmondnet.

Great link tho'