Doctors’ chief says England must follow Scots lead on NHS funding
Published Date: 08 July 2008
By LYNDSAY MOSS
HEALTH CORRESPONDENTENGLAND must follow Scotland in the way it funds health services, by shunning the private sector and not forcing competition into the NHS, the leader of the UK’s doctors said yesterday.
Dr Hamish Meldrum, the chairman of the British Medical Association (BMA), said the NHS in England had to get rid of the “damaging market in healthcare”.
The concerns, highlighted at the start of the BMA’s annual conference in Edinburgh, were echoed by doctors in Scotland.
Scotland has increasingly moved away from England in the way it runs the health service.
In 1990, the Conservative government introduced the internal market system in the NHS, whereby hospitals have to compete to win contracts from health authorities and GPs.
In 1997, the Labour Party’s manifesto pledged to get rid of the system.
The conference, attended by more than 400 doctors, also heard of other differences, including increased private sector involvement and the prospect of so-called “polyclinics” south of the Border.
Dr Meldrum, who was born and trained in Edinburgh, said: “Devolution has always been portrayed as the three Celtic nations breaking away from England. In the case of the NHS, it’s been the other way round. England has broken away from the rest of the UK.”
Dr Meldrum said there was no evidence the internal market had increased efficiency and decreased costs and praised the move away from the system in Scotland. He added:
“The BMA wants to see an NHS untarnished by a market economy, true to its beginnings, giving the public a fair, caring, equitable and cost-effective health service – not a service run like a shoddy supermarket war. If it can be done here in Edinburgh, it can be done in England.
“Let’s stop pretending that healing the sick is like trading a commodity. Let’s stop diverting doctors’ energies into unholy bidding wars for jobs they already do. Let’s follow the Celtic lead and get rid of the market in healthcare once and for all.”
Dr Meldrum added: “I’m not saying that everything’s perfect north of the Border, but at least there seems to be a shared agenda, a willingness and an eagerness to pull together that you don’t see south of Hadrian’s Wall or east of Offa’s Dyke,” he said.
Dr Peter Terry, the chairman of the BMA in Scotland, praised the SNP government’s approach to the NHS in Scotland and said doctors supported the principles underpinning their policies – to maintain a universal and free health service based on clinical need. He said:
“I think the English should follow us. I didn’t like it (the internal market] and I don’t think anybody did. It did not seem to be of any benefit to patients and the administration costs were huge.”
Dr Terry also criticised increased private sector involvement in the NHS in England.
“I no longer recognise the NHS in England as the NHS as it was initially intended,” he said.
A spokeswoman for the Scottish Government said: “The Scottish Government is committed to the principle of a mutual, collaborative NHS in Scotland rather than a competitive market approach adopted elsewhere in the UK.”
BACKGROUND
WHEN the internal market was introduced into the NHS, the idea was to drive down costs and increase efficiency.
In England, GPs or primary care trusts are given a budget they must use to commission services from other parts of the NHS. For example, if they have patients with diabetes who need to go to a consultant-led diabetes clinic, they must buy this service from a hospital. So hospitals compete to attract patients to receive the money for providing that care. The internal market has helped the private sector establish itself as a provider within the NHS. It has also helped support the “patient choice” agenda, whereby people have a say in where they are treated.
Scotland abolished the internal market almost ten years ago.
Health boards are given a budget calculated using the Arbuthnott formula, which takes into account factors such as population size, death rates and levels of deprivation. The health board then decides what services to fund, using that budget. GPs do not have to commission services; they send patients to where they believe they will get the best care.
While doctors have praised Scotland’s shunning of the internal market and opposition to the private sector, others suggest these factors have helped to drive down waiting times in England, which is on track to meet an 18-week total waiting target by the end of the year, compared with a 2011 deadline in Scotland.
Doctors persuade government to block GP practices run by private firms
A LEGAL loophole which could make it possible for private companies to run GP practices and other health services in Scotland is to be closed, the health secretary will announce today .
Nicola Sturgeon is due to address GPs at the British Medical Association conference in Edinburgh, and is taking action to end any possibility of private firms getting a foothold in the Scottish NHS, as has happened in England.
The move comes after doctors called for a campaign to close loopholes in Scottish legislation that would allow the private sector into the NHS.
While the SNP-led administration has signalled its opposition to the involvement of private companies, doctors had feared that this could change in future, especially if a different party came to power.
A motion put forward by Scottish doctors at the BMA conference urged the association to call for legal amendments to block private provision of services.
Currently, private-sector involvement could be allowed under three separate pieces of legislation.
But Ms Sturgeon’s announcement will ensure such a possibility is put out of reach.
A Scottish Government spokeswoman said: “Nicola Sturgeon has always made clear that she does not see the NHS in Scotland moving towards more private-sector involvement.”
In 2006, private company Serco made a bid to manage a GP practice in Harthill, Lanarkshire, but was unsuccessful.
However in England, several GP practices are now run by private firms and there have been concerns that if such companies, including Serco and United Healthcare, establish any kind of foothold in Scotland then the situation will escalate.
Dr Peter Terry, chairman of the BMA in Scotland, said: “Concern about private-sector involvement in primary care is that it will be driven by profit.
“It also relies more on locum doctors to provide the service, meaning you do not get the same continuity of care you would from a regular GP.
“The service ends up being more fragmented, which does not help patients.”
Spotted in The Scotsman
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“Three Celtic nations”? Racist twit!
July 8th, 2008 at 10:14 amUmmmmm. How about a comment on the article itself, rather than professing your own bizarre paranoia?
July 8th, 2008 at 12:34 pmPersonally, I think the countries simply have different needs and mechanisms, due to the population difference and infrastructure. What might work well for England might not for Scotland, and vice versa. ;o)
July 8th, 2008 at 12:44 pmThe point is, Alba, that it should be up to an English government what the English NHS does and not British nationalist MPs from Wales, Scotland and NI. We had foundation hospitals imposed on us against the wishes of MPs elected in England by Scottish Labour MPs. This can’t happen in Scotland, Wales or NI because they have their own government, as you will understand perfectly well working in a devolved government department yourself.
July 8th, 2008 at 12:52 pmDr Meldrum is of course from Scotland. There is no record of him ever condemning the Barnett Rules which are the single and central cause of England’s health funding problems.The BMA as a whole, which is heavily dominated by members from Scotland , Wales and English supporters of the Labour government, has been consistent in burying for many years any discussion of Barnett. The BMA has a well funded and busy news management section and yet, Soviet-style, while it is active in refuting and government policy it never dwells upon the constitutional situation which underlies it.
Specifically, the BMA never mentions or draws a veil over
1. The Barnett Rules -see above
2. The fact that there are now four NHS’s with England
funded the least well for many years.
3. The fact that England and the English NHS are ruled
by the British government. In its announcements and
publications the BMA frquently mentions the
Scottish and Welsh adminstrations and
parliament/assemblies so cannot be unaware of the
assymetry and injustice.
Ironically,the BMA, having been a firm supporter of Blair and Brown (and thrown the weight of the BMA heavily behind the Lbaour party in the 1997 election) have now fallen out with the government and are engaged in an ongoing firefight. They are becoming fairly freindless , Meldrum in particular , especially after his announcement that patients ie English patients should be denied NHS treatment if they attempt to “top up” their therapy.
Meldrum knows full well that this applies only to English patients and that in Scotland, because of the massively excess funding at English expense such that all the latest drugs are provided free by the Scottish NHS, there is no need for this .
Alba , recognise one of your own .
July 8th, 2008 at 4:37 pmI seem to remember in 1997 that the Labour headline was “24 hours to save the NHS” as the Labour party was claiming that the Conservative party were going to privatise the NHS. Who’s doing the privatising then?
On the question of funding of NHS services in the four nations as the power over the NHS has been devolved in Northern Ireland, Scotland and Wales then funding should only come from taxation raised in those countries for devolved services. It is undemocratic that England pays a large part of the funding for the devolved powers, yet our representatives in parliament cannot hold those people to account for that funding. The Americans had a war with us on this principle and we lost. That principle “No taxation without representation.” Oh and by the way before these countries should be able to start spending on the devolved powers, they should pay the funding to the national government for the powers it still holds universally of all threee nations in and that funding should be in proportion to their respective populations.
July 9th, 2008 at 3:12 amFair enough Wonkostane, as I’ve cited before, you’ll not get an argument against proper English representation from me - and I there’s no love lost here on Brit-nats either. Again, I can only say bring it to them direct as best you can…
….and lobby your own Aelwulf. If I were English I’d be mad with frustration.
Hey Wonko - doing a bit of digging have we? What prompted that? ;o)
July 9th, 2008 at 7:39 amIn other news, I trust we have your support here?
http://news.scotsman.com/latestnews/Glasgow-East-byelection-Labour-launchs.4266160.jp
A Labour loss would damage Gordon Brown and planet Brit-nat in a very big way.
Personally, can’t see it happening. The people of Shettleston have long lived in squalor and poverty - and they seem reasonably happy to keep voting for the people who do nothing but keep them there. Massive majority, but stranger things have happened.
The dreary Margaret Curran is the Labour candidate - yet another Scottish Brit-nat you guys will doubtless welcome into the fold when she forces unrepresentative Brit-nat policies on you, at the expense of English representation.
I was amazed during last year’s election when, after having her majority comprehensively slashed by the SNP, she started ranting [on assumption it seems] about SNP members intimidating her. One has to laugh, giving that previous successive Labour tabloids and the ENTIRE Labour election campaign in Scotland was a case-study on ‘how to intimidate and scaremonger your way back into power - in a really transparent manner’. Media fascists, and then some. To this day I can’t get over their lying and purposeful deceit.
Anyway - Shettleston loss for Labour = tata Gordon.
July 9th, 2008 at 7:52 amMs. Curran in action. Anyone have a tranquiliser gun?
http://www.youtube.com/watch?v=FHbGCR6lutY
July 9th, 2008 at 7:53 amLiebour are buggered whichever way you look at it. They desperately cling to power in their celtic heartlands but the SNP (and even the Illiberal Dumbocrats which must be embarassing for Liebourites) are rapidly whittling their support away in Scotland and Plaid are slowly creeping up on them in Wales. I wouldn’t be surprised if they tried to establish themselves in Northern Ireland in a desperate bid for votes. The Greens and UKIP are the only mainstream parties to field candidates in all four home nations.
July 9th, 2008 at 8:09 amDr Meldrum …A Willingness & Togetherness ! all very cosy when your getting all your own way ! nice big trough to feed into! everything on a plate !in your world…HERE 50 million Taxpayers in a long NHS queue, grow old gracfully NO CHANCE in ENGLAND… makes me sick to the stomach with the injustice of it all, so Who can we turn to for representation & fairness ! while we are scoffed at by Celtic racists !… we have our own celtic nitemare Heathcliffe Brown & Co .. if ever we need some drastic changes !it needs to be Soon !
July 10th, 2008 at 1:26 pm