Is England a Foreign Country?

The parties’ general election manifestos show just how different health policy in England has become from that in Wales.

The manifestos, of course, are talking about the English NHS. Superficially, England and Wales seem to share some objectives, such as improved access to care, protecting investment in the NHS, and spending money wisely. But the latest eye-catching ideas from England seem to have little to do with Wales.

The three main parties all agree on the key issue for England – how to drive up the performance of the NHS. Their shared recipe has three ingredients: help NHS workers take over and run their own services; encourage a range of provision; and give people lots more information on how well local services are performing.

This is as far from the debate in Wales as would be discussion about the merits of SATs in schools, or the transport infrastructure around the Olympic stadium.

Our ingredients for driving up performance include getting the public sector to work together, encouraging clinical networks and benchmarking, and a strong steer from the centre.

Contrast this with English Labour, where all the talk now is of getting good performers to take over the poorer ones, enshrining patient rights in legislation, and making primary care available from “8 ‘til late”.

The difference is startling, as is the consensus amongst the main parties in England.

None of this difference need matter, of course, and actually it might be a good thing to experiment with different approaches and see which works best. A moment of quiet reflection, however, might reveal a paradox: how can we be proposing two so completely different approaches to improving the NHS – to achieving essentially the same goals? One might wonder whether anyone actually knows which approach is best, or whether we are not all going with our gut instincts and the herd?

Surely not.

Written by Professor Marcus Longley, Director, WIHSC

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4 Responses to Is England a Foreign Country?

  1. theagingfanboy says:

    I don’t think “choice” is the right term. Lots of people in Government want to help sick people, they dissagree on how to do it, but the commitment is there. The Thatcher reforms weren’t suported by a majority of people in England, and yet Welsh Tories loved them. John Major’s government was kept in office by the Ulster Unionists. You can’t just exploit the system when it suits, and then cry that it’s an English plot when it doesn’t.

  2. Marcus Longley says:

    One of the ironies of this situation is that if English voters want any choice about their NHS, they’ll have to move to Wales!

  3. Iwan Dowie says:

    A ‘catchy’ headline! England is not constitutionally a foreign country, and whilst policy differences exist between the devolved nations that constitute the United Kingdom this is no different to any other federal based system adopted elsewhere in the world. Even before the establishment of the Welsh Assembly, Wales enjoyed (or suffered) subtle differences. Peter Walker as Welsh Secretary adopted a more social pathway during the late 1980’s in contrast to the more radical policies adopted by Mrs Thatcher for the English NHS. However the problem which continues to exist is that Wales is wholly dependent upon Westminster for funding, and as a result health care spending is to a certain extent controlled by the generosity of central government. For example serious questions are being asked upon the futility of free prescriptions for all within Wales, and may well become one of the first ‘victims’ of a healthcare cut if funding for Wales is severly reduced. Wales prides itself in following a socialist and inclusive pathway, yet paradoxically Wales is bound by the complexities of a capitalist union. Wales’ (and to an extent Scotland’s) abilities to pursue a path of difference is bound to a certain extent by the willingness of England and it’s public in allowing this difference. There may come a time when England decides for itself that it is a foreign country leaving the bill for a seperate healthcare system to rest entirely with the people of Wales.

  4. theagingfanboy says:

    I love these inclusive pronouns. Who is “we” in these circumstances?

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