Having been in Scotland for 18 months I have had the temerity to put in writing some points of interest for others in the UK – please have a look at my short commentary on Health Matters, Health in Scotland: Growing Divergence – coming disputes. This contribution could be read as an overlong promotional appeal to read this article. As a taster…the main points I raise are: how the Scots will deal with the CSR, and how they will adjust the Barnett Formula allocations to their priorities.
I also comment on the recent arguments about the Nuffield Trust paper on comparative efficiency and the riposte in the BMJ by Peter Donnelly now Professor of Public Health at the University of St Andrews ( all references on the Health Matters site). One thing I notice in Scotland is that the empiricist and positivist spirit of David Hume still pervades the Scottish public service as there is a wealth of well ordered data, and an expectation that it is used in making arguments that contribute to the application of public funds that I find refreshing. It is therefore strange that the comparison of devolved administrations is so difficult and it makes one wonder if this is more conspiracy than the other compound words beginning with “C”.
With all that data will it be no surprise that performance management particularly from government officials would be familiar to most other parts of the UK ?
In public health terms Scotland has a problem, and again its data proves useful in spelling this out in detailed indicators.
Another feature of Scotland is the close engagement that academics have in policy setting and this is demonstrated in the work around inequalities. The CMO in Scotland, Harry Burns, has been a tenacious leader in tackling inequalities. His thinking is wide ranging and innovative and can be found in his 2009 annual report (again reference at the Health Matters article). The Scottish refresh of its inequalities strategy is “Equally Well” whose half term review is found…(yup you’ve guessed at the Health Matters article)
This year has seen attempts by the Scottish Nationalist Party-led government to introduce a minimum price for alcohol. My more measured comments on this are in the Health Matters article, but in the relative privacy of a blog audience I am sorry this issue has become mired in politics.
Scotland and its people have “a difficult relationship” with “the drink”. And from recent data it appears to be worsening. The Scottish Government advised by the CMO based on the Sheffield pricing study identify minimum pricing as a measure that could be taken and within the Scottish Parliament’s powers. However, the Scottish Government is a minority and it has not found consensus, the Scottish Labour Party introducing a Commission which has looked at other options other than minimum pricing such as greater use of licensing powers and referring the pricing issue back to Whitehall and excise duty. I personally think this is unfortunate as the opportunity to introduce a step changing measure has been lost. Never has such concern been expressed for the moderate drinking public.
Other interesting features, again can only be fully enjoyed on the Health Matters article, relate to the election of members to Health Board in Fife and Dumfries and Galloway. It brought to mind a comment made by Morton Warner when introducing the innovative “people-centred component” of the Welsh Health Planning Forum in the early 90s. John Redwood was Secretary of State and was a little concerned how public engagement might operate. The Welsh Office official fed back to Morton that he could try any method of public engagement “except democracy” – well you don’t get a better recommendation than that.
Written by Dr Edward Coyle, WIHSC Associate