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Should the NHS drop the 'N'?

Mark Easton | 16:52 UK time, Friday, 1 April 2011

There will be some who regard the fact that NHS patients in England are now the only ones in the UK who might have to pay for prescriptions as evidence of unfairness. 90% of items are issued free even south of the border, but those who are eligible contribute £450m a year to the pot - equivalent, the Department of Health says, to the salaries of 18,000 nurses.

It is a question of priorities, ministers argue. Variation is an inevitable consequence of devolution and localism. These days, the national in National Health Service is about an over-arching philosophy not, as the government might put it, one-size-fits-all policy.

Success, they contend, should be about value in terms of outcomes, and analysis of the differences between England and Scotland on this score is revealing.

While per patient spending in England is roughly £200 less a year than Scotland, on almost any measure, the English NHS performs as well or better: on waiting times, productivity, patient satisfaction and mortality rate (Nuffield Trust NHS efficiency report [429KB PDF]).

Graph showing NHS expenditure

Even when one takes into account deprivation and geography, experts insist the NHS north of the border appears less effective for more money.

This difference has even been given a name: "the Scottish effect". Scotland's taxpayers might wonder whether that is fair.

Comments

  • Comment number 1.

    More divide and rule.

  • Comment number 2.

    Not National Heath Service, but NIHS, WHS, SHS and EHS different rules depending on your postcode - didn't the politicians on all sides say that this is what they were trying to avoid!

    (or in native tongues) NIHS = SSnET (Seirbhís Sláinte na hÉireann Thuaidh) and NIHS! , WHS = CHG = Cymraeg hiachâd Gwasanaeth and SHS = SSnA (Seirbheis Slàinte na h-Alba)

  • Comment number 3.

    Mark

    I usually enjoy your articles but this time you are well wrong.

    Firstly, the Nuffield report you refer to was widely ridiculed following release. From academics and NHS professionals, including the BMA. It used flawed methodology and dodgy data. Your other link to the Journal of Health Services Research & Policy is by the same author of the Nuffield report and uses the same poor methodology and data.

    Where is the evidence that patient satisfaction is higher in England. On waiting times, the recent Office for National Statistics figures showed that Scotland generally performed better. Productivity? - point us to the evidence which properly compares England and Scotland - I bet you can't. Mortality - yes mortality rates in Scotland are mostly higher but is that the fault of the NHS?

    Comparison of performance across the UK deserves a proper evaluation but this isn't it. Poor show.

  • Comment number 4.

    Mark

    You refer to 'the Scottish effect'. Yes this term has been used but not for these differentials. Please do some proper research.

  • Comment number 5.

    I find this completely hilarious at the English reaction to this story. Mostly all ill informed. Not really helped by a bias and uneducated media, whose main objective is to stir up as much reaction as possible. I recomend that the English do some growing up and start questioning their own MP's to the real reasons as to why they cannot have free prescriptions. The fact that English tax payers DO NOT subsidise the other devolved Nations, should also be highlighted instead of being buryied by the media

  • Comment number 6.

    Those people discontented with the devolved areas having free prescriptions should realise that the money used for this purpose is taken from a fixed budget. This means that free prescriptions may well be to the detriment of some other part of the health service. So while someone may be getting a free dose of prescription medicine , the missing cash may well deprive someone else of some very necessary care. The devolved areas are not "getting something for nothing " there is a price to pay which may not be to the advantage of all.

  • Comment number 7.

    it is interesting that free prescriptions in Wales and Northern Ireland were not an issue while England And Scotland still paid prescription charges, then when Scotland acheived free prescription charges, all comparison is given between Scotland and England, Why? if a true comparisonis to be made effectively then All Scotland England, Wales and Northern Ireland should equally be described.
    As to the point of the subsidising of Scotland by England, I have little real wish for an independant Scotland, however, as a Scot I wish to be self sufficient in my finances and if I am in some way leeching on others no matter their nationhood if I am then bring on independance, for I would rather be totally independant, standing on my own two feet than being a burden on others.

    Perhaps though the reason a great many of the unionist parties do not want te break up of the union is not their great affection for the Scots, Welsh or Irish, But that ALL Scotland England Northern Ireland and Wales not only should but are valuable to Britain as a whole!

    So perhaps those at the BBC should leave their ivory tower in the south and practice being the British broadcasting corp. not patronising little Englanders.

  • Comment number 8.


    "This difference has even been given a name: "the Scottish effect".


    No it hasn't. The term 'The Scottish Effect' was first coined years ago with regard to the higher mortality rate in Scotland.

  • Comment number 9.

    I agree with some of the posts above - there appears to be an obession in the English based media with any differences that appear to benifit Scots over the English. Most of it is pure garbage.

    I am yet to see an article on why the Scottish roads are so much worse than the English roads - and why less is spent on Scottish roads than English roads! Maybe its because the money is being spent on things like free prescriptions. The English appear to want to focus on the apparent good bits in Scotland but ignore the bad that comes with taking the money from elsewhere.

    Scotlands NHS does appear to provide less value for money and frankly I think this needs looking into. I also dont think we need to be giving out free prescriptions - its a well timed manouver by the SNP heading into an election. It has the double wammy of making them look good and creating angst with the English.

    As for subsidies the last balanced report I read from the financial times basically said taking Oil/Gas into account Scotland spent roughtly what it raised. Its subsidised by no one yet certainly does not get value for money from what it spends.

    I think the NHS in Scotland is just proof of the position the country is in - as Scotland does not take responsability for what it spends and always has someone else to blame we never get to the bottom of the lack of value for money.

    Personally I think a federal UK is the way forward and the Country (UK) needs an overhaul. I also think that the English based media (and the millions of little Englanders its created with its scaremongering) need to get a reality check and look at all the facts - not just the ones that sell papers/create interest.

  • Comment number 10.

    Oh dear poorly informed comment, from a poorly informed journalist just about sums up the BBC's understanding of devolution. NHS Scotland by the way pre-dated devolution... As has also be pointed out of the various constituent parts of the UK only England remains charging for prescriptions. Northern Ireland and Wales having beaten Scotland to this.

  • Comment number 11.

    One thing comes out of every medical study ever undertaken: the poorer you are the more unhealthy you will be. And so if government really wants a healthy population it had better start the great process of equality between richest and poorest, not just because it is moral and good, but because it is the best form of preventative medicine there is.

  • Comment number 12.

    I question the £450m a year - for the salaries of 18,000 nurses. Will English prescription payments pay for 180.000 Nurses in the English Health Service or UK wide?
    English Monies collected and spent on the English Health Sevice will attract the consequentials of the Barnett Formula sending extra cash to scotland wales and NI where they can spend the money in whatever way they fancy.

  • Comment number 13.

    Typical bbc reporting, trying to make england think we are being treated fairly,mark easton is twisting the fugures to that end,we are not fooled by this type of reporting.

  • Comment number 14.

    Should the NHS drop the 'N'?

    I agree with Mr Easton ... drop the 'N' and use the 'G' for Global as our health service is now the globally abused health service ... where immigrants, who have never paid a penny into the UK system can receive millions of pounds a year in free treatment when people like myself who have regularly paid into the system for 35 years ... are 'skin-flinted' and refused basic minor operations/higher cost medicines etc by the NHS (many of them foreign doctors now making such decisions).

  • Comment number 15.

    I agree with nautonier 100% it is has become a global service, the BBC are giving plenty of publicity to the free prescriptions available in Scotland but not much about NHS tourists. While we are discussing this change how about replacing the B in BBC with G as the same thinking appears to apply. The BBC mission appears to be apologists for the poor down trodden asylum seeker, illegal immigrant and any immigrant who has not complied with our laws.

  • Comment number 16.

    To Edward 2010,

    When Scotland stops getting an extra £1,600 for every man woman and child more than England thanks to the skewed Barnett Formula then maybe you can tell us to stop complaining. If it were the other way around I'm sure the Scots would be rioting on the streets. The English are too tolerant and their resentment is long overdue and it's time our elected politicians got kicked into action and demanded the same recognition as every other nation (oh, I forgot England isn't recognised as a nation is it?) in this un-united Kingdom. What I don't understand is all the England bashing whether it be about prescriptions or tuition fees, it would be nice to sometimes hear those outside of England agree at how unfair England is being treated. If not, maybe it would be best to keep quiet and mind their own business, something their MPs at Westminster should have a mind to do too.

  • Comment number 17.

    Held commenting on this as i didn't realy follow this untill yesterday.
    Were we are we have a recently build state of the art walkin centre that contains 2 doctor surgeries and a dentist upstairs various support services and then on the other side of the building a fully functiong walkin were xray and treatment can be provided almost instantly, could say its an old school cottage hospital.

    This is worth paying a prescription for. Im not entitled to free prescriptions as Im on incapacity old rules and not the new system so dependent on the pharmasist some months I pay some I dont as the newer ones feel there should be no differance between patients on benifits.
    should replace the N with a D for devolved as the money is paid the same way to the trusts its how they spend it that matters. The only benifit to a free prescription is a well workforce and content peoples. Ive lost a lot of teeth through medication and cant get them fixed thats about my only brief grief with this current spending differance. Ive tried to say it was due to medical intervention im my life and health but they will not recognise that floride and anti depressants cause a calcification of the immune system in the mouth.

  • Comment number 18.

    The four UK nations are drifting further and further apart. The real answer for England is for England to declare independence. Scotland Wales and N.Ireland must make their own decisions. If they want to continue in a UK without England that's up to them but England should leave.

  • Comment number 19.

    The BBC went to great pains to give the impression that it is not a one way street by saying on its news report last night that:-

    1. England has free prescriptions for cancer patients:

    2. English cancer patients are guaranteed to see a specialist within one week, those in Scotland are not.

    3. England has been given £200 million for cancer drugs (I thought it was £50 million and I think I'm right see below).

    Each point can be answered thus:

    1. English cancer patients are denied several cancer drugs freely available to patients on the Scottish Health Service. So what do they get free on prescription? Painkillers?

    Remember the case of George King who was going to move to Scotland for cancer treatment?

    http://news.bbc.co.uk/1/hi/england/tees/6260543.stm The BBC might like to follow up that story to see how he faired.

    2. All seeing a specialist within a week means for many patients in England is that they get to know sooner they have a cancer that they will be denied drugs for. So they have that bit longer to know they are going to die.

    3. The cancer drug fund was meant to be temporary and does actually now pay for some drugs previously denied. However, Scottish MP Eric Joyce immediately asked in PMQs whether this fund had Barnett consequentials, meaning more money for Scotland.

    http://www.publications.parliament.uk/pa/cm201011/cmhansrd/cm101206/text/101206w0001.htm
    Quote:
    Cancer: Drugs
    Eric Joyce: To ask the Secretary of State for Scotland whether the Scottish Government will receive a budgetary uplift as a consequence of the allocation of £50 million by the Government to the interim cancer drugs fund. [28803]
    Michael Moore: In July 2010, the Secretary of State for Health, the right hon. Member for South Cambridgeshire (Mr Lansley), announced that from October patients will have greater access to cancer drugs that their doctors recommend for them due to an extra £50 million in funding being made available by the Department of Health. There are no new Barnett consequentials for the Scottish budget as a consequence of this policy.

    ....No Barnett consequentials for Scotland eh? Well diddums. I feel as sorry for Scottish cancer patients as Scottish MPs do for English cancer patients, if Mr Joyce's reaction is anything to go by.

  • Comment number 20.

    To those complaining that England (or parts of England) get hard done by compared to Scotland, perhaps you should check the total social spend figures, including infrastructure such as high-speed rail links.

    English residents complaining about Scottish MPs voting on English issues? - it shouldn't happen, I agree and you should complain to your MP.

    English residents feel that they want devolution or independence - good idea, get on to your MP.

    Health spending? - perhaps you want to look at English (especially parts of England) expenditure on private healthcare, try adding that into your comparisons. And why not consider how much is given to England to pay for PFI contracts? And how much profit is made by private companies on the back of NHS contracts? I'd suggest you think about these matters before you start complaining about how disadvantaged England is.

  • Comment number 21.

    #19, referring to Eric Joyce.

    Please be advised that very very few people in Scotland would wish to have Eric Joyce as a representative. Highest MP expenses (in the UK, no less) in three of the last five years, recently banned for drink-driving (and refusing to give a breath test), and lots more.

  • Comment number 22.

    Whenever there is any comparison between Scotland and England, someone (or more) Scottish comes rushing out to say they are not subsidised. They mention the oil but not the financial services revenues etc. etc.. They avoid mentioning the Barnett formula:

    In actual monetary figures, this will work out as (per person):

    * England £7,121
    * Scotland £8,623
    * Wales £8,139
    * Northern Ireland £9,385

    In fact, if you read that wikipedia article based on Public Expenditure Statistical Analyses from 2007 you will also see that I, living in the East of England benefit from only £6,144, the lowest region in the UK - nearly 30% lower then someone in Scotland.

  • Comment number 23.

    @ AMJHAJ

    I know for sure that the BBC is inundated with calls for an English Parliament. However, it doesn't even have an English webpage like it does for Scotland and Wales. MPs in England are similarly pestered about an English Parliament, but all they do is churn out the same standard reply saying they don't believe one is necessary.

    The reason for this is OBVIOUSLY because they know that an English Parliament will make them all pointless. Look at the arch-hypocrite Danny Alexander who is eager to sell English forests and impose full tuition fees on students from England. No doubt he also voted for increased prescription charges in England. He has no say on forests being sold in Scotland, although he campaigned against the SNP's proposed sales. He was reduced to campaigning because he doesn't have a vote in Scotland. That means he had no say on free prescription charges in Scotland. An English Parliament would put Danny Alexander out of a job. Not only him, but every other MP, not only those from Scotland.

    The same MPs who voted to allow the Scots a referendum on a Scottish Parliament are adamantly refusing we English a referendum. All they care about is keeping their jobs. So, you saying we should lobby our MPs is easy to say, but their attitude to England is exactly the opposite to that to Scotland. No MP has signed the English Claim of Right or recognised the English Constitutional Convention.

  • Comment number 24.

    @ AMJHAJ

    Firstly, if you are going to talk about "parts of England" (meaning regions) then please start talking about parts of Scotland too. The regional carve-up of England is a major bone of contention with English people. We never had a vote on a nation about them, but it is clear we do not want them.

    Healthcare needs in Glasgow are possibly different than those in the Shetlands, but we see little talk about needs differences within Scotland. Anyway, England is the business of the English, not Scottish MPs.

    PFI is a good point to raise. Is the private money in PFIs included in Barnett consequentials? I doubt you know any more than I do.

  • Comment number 25.

    Two issues here of course - break up of the disunited kingdom, break up of the old NHS.

    I have no problem whatever with Scottish or Welsh people making a decision about whether to pay for prescriptions by cash on the day or by tax from their pay packet - I do have an objection to them deciding that I should pay for it through tax from my pay packet. I really do think it is time to break up the disunited kingdom properly and completely - ie full independence for England. Scottish and Welsh people would then be able to make any decisions they wished.

    On the old NHS, it looks pretty clear that it will have been broken up and largely privatised by the end of this parliament. Some will be unhappy, others will applaud.

  • Comment number 26.

    Theres some serious paranoiah in England about Scottish politicians. Danny Alexander is not part of some huge Scottish consipracy to break up England - what are people putting in their porraige down there?

    The reason the BBC has Scotland seperate as its nothing more than a region to them and is treated as such. I find it amazing that people up here complain Scotland is treated as no more than a region and people in England are complaing they are not!

    As for the barnett formula Clive Hill the simple facts are the report by the financial times and oxford uni stated that yes Scotland was getting more per head in money than England. We know this - what it also stated was more per head was being raised in Scotland including the Oil/Gas. So hence Scotland was not being subsidised but should it go independent would not have been any richer.

    The fact the SE gets so little if kind of meaningless - Scotland gets more than most English regions - but then my region of Scotland doesnt see that as its relatively well off and healthy (has 80% employment compared to 60% in London) - Strathclyde on the other hand probably eats up a huge amount of resources with lots out of work, on benifits and a very low life expectancy.

    Papers and the media love to paint this black and white picture but its completley wrong most of the time - there are people in England that sit all day watching Kilroy and living on benifits that think they are subsiding Oil barons in Aberdeen as they read it somewhere. I personally dont have a problem with the correct amount of resources going to the places in the UK that need it most - at the moment no one cares about that. Its all a proper Maggie Thatcher "me me me" type argument. Those Scots have too much - cut them off etc. Very grown up and well thought out - the Daily Mail (former Nazi supporting paper!) has a lot to answer for.

  • Comment number 27.

    ME

    "Variation is an inevitable consequence of devolution and localism".

    Level playing field? English Parliament anyone?

  • Comment number 28.

    Everybody seems to be missing the reason free prescriptions have been introduced. If you are charged for a prescription, you are less likely to seek medical advice for an illness that may be serious, because of the potential cost of medication. Take that barrier away and more life threatening problems are caught earlier and subsequently cut the cost to the NHS. This is a simple fact, the English should be using this cast iron argument to demand the same for themselves. But no! They ramble on about the outdated and totally discredited Barnett formula figures, suggesting the Scots are a bunch of freeloaders. Can I point out the massive revenues generated by oil produced in Scottish waters, the huge gas reserves being pumped to England, bypassing all but the largest population centres in Scotland to make sure almost all English homes have mains gas. The fact that Scotland is a net exporter of electricity yet we are charged more to feed clean, green energy to the grid than a coal fired power station near London.
    Be careful what you wish for my English neighbours. When/if we do become independent, I foresee a lot more respect coming our way as you negotiate your power and water needs from your energy rich former "colony".

  • Comment number 29.

    2. At 17:48pm on 1st Apr 2011, John_from_Hendon wrote:

    Not National Heath Service, but NIHS, WHS, SHS and EHS different rules depending on your postcode - didn't the politicians on all sides say that this is what they were trying to avoid!


    'Twas ever thus.

    THE National Health Service is an England-only institution, with "NHS Scotland", "NHS Wales" and "Health and Social Care Northern Ireland" providing comparable services in their respective jurisdictions.

    In the same way, the "UK" Department of Health is an England-only department; indeed, around one-half of the UK Cabinet have responsibilities which don't extend beyond England.

    It is high time that there was an English First Minister - say, the Home Secretary (most of whose responsibilities are England-only, and the remainder could be hived off to Ministry of Defence and FCO) - and only those offices of state which are truly UK-wide constituting a UK Cabinet (PM, Chancellor, Foreign Secretary, Defence Secretary, etc.) together with representatives of the nations.

    Get rid of the House of Commons and House of Lords, and replace them with a Government of/for England and the UK Government!!

  • Comment number 30.

    The NHS difference between Scotland & England is one more belated & welcome nail in the coffin for the union. It seems inevitable that in my lifetime I will see the UK broken up & my Scotland once again in control of its own borders & all that exists within them come good or bad. That day cannot come soon enough for I shall be delighted when power grubbing Ministers of the Scottish Office get booted out of Westminster & sent home. The inequitable control they have in the UK, especially over England is a disgraceful arrangement. English voters must have total control of their own affairs & I wish them well.

  • Comment number 31.

    Thank you Mark
    This just shows yet again that England need to get rid the dead wood in the Union.
    I am sick of Scotland and the rest of them allowed to make up laws that people living in England have to pay for. We should be calling for an England only Parliment and lets call for devolution.
    Why do they get more money to spend and put less money in then England.

  • Comment number 32.

    31. At 06:31am on 3rd Apr 2011, MARC wrote:

    I am sick of Scotland and the rest of them allowed to make up laws that people living in England have to pay for.


    ---

    This is an oft-repeated line which I really would like to understand (but I don't).

    Scotland's residents gets something - say, free nursing care for the elderly or (as here) free prescriptions - which English people don't get.

    Why is it that the inclination of [English] commentators is to try to remove that privilege from the Scottish people, rather than insisting that their politicians proffer the same service to English residents?

    I would like to see all people throughout the UK treated equally, but where there is a current discrepancy, I would far rather have the Scottish principle (the State looking after the weak and vulnerable) in place rather than that down south (look after yourself, or no one will)!


    More generally,

    The Scottish Government is given a block grant, to spend as it sees fit having regard to the priorities established by the Scottish Parliament. The grant can only be spent once, and if sums are spent on particular projects, then those amounts will not be available for other projects: this is the democratic process in action!

  • Comment number 33.

    #30 Graham Harris Graham

    Thank you kindly sir! I join you in wishing for all Scottish MPs to decamp smartly back to Scotland.Then the very words "England" and "English" can once again be
    used rather than "British" and "Britain".Scotland should indeed manage its own affairs
    as should England.Any arguments concerning the NHS would then be invalid.

  • Comment number 34.

    "There will be some who regard the fact that NHS patients in England are now the only ones in the UK who might have to pay for prescriptions as evidence of unfairness".

    There will be some who regard the English as the only people left in the Union with no democratic representation as having a lot to do with this.

  • Comment number 35.

    "90% of items are issued free even south of the border, but those who are eligible contribute £450m a year to the pot - equivalent, the Department of Health says, to the salaries of 18,000 nurses."


    Just how true is this proposition?

    Does the £450m include the administrative costs of differential processing of prescription claims (including verification of patient eligibility where exempt; if all were free, no verification would be necessary) as well as staff and IT costs?

    If one was starting with a clean sheet of paper to design the NHS, all prescriptions would be free - if for no other reason than that the issuance of a prescription indicates a patient's NEED for a medical supply - and that was indeed the case when originally set up.

    It is far easier to administer a one-rule-for-all system, and all NHS prescriptions SHOULD be free, notionally paid for through National Insurance payments.

    When it comes to government finances - Keep It Simple, Stupid! (Recent governments have omitted the third word, and so they have simply kept it stupid!!!)

  • Comment number 36.

    I think Scots and English alike should stop letting Mr Easton and his ilk talk down the union and spread division between us. The whole aim of these people is to break the UK into manageable, bite-sized chunks for the EU to consume. In order to accelerate this process, the BBC is talking the UK economy into recession to make us fight each other for the reamining dwindling resources:
    "UK manufacturing grew at its slowest pace for five months in March as new orders dropped following a slowdown in consumer spending, a survey has found.

    The Markit/CIPS purchasing managers' index fell to 57.1 last month, down from a revised 60.9 in February.

    A score above 50 indicates growth in the manufacturing sector."

    Meanwhile in their beloved USSR:
    "Russian manufacturers geared up in response to the strongest rise in new orders since 2008.

    The sharp rise in overall demand came in spite of rising prices and weaker exports, HSBC said.

    "The PMI report draws a benign picture of fast growing manufacturing that can hardly catch up with the rising demand, increasing employment, and reducing inventories," according to Alexander Morozov, chief economist for Russia and CIS at HSBC.

    The PMI reading rose to 55.6 in March, up from 55.2 in February. The new orders index rose to 58.2, up from 57.3 in February."

    See the difference there? Anyone?
    And the SNP making us row about oil is the biggest lie of all designed to wind people up. The oil is in the North Sea. Not Scotland. Not England. Not British waters, which end 3 miles out. They are a resource which have been found, exploited and profitted from by all the skills of the British working man and engineering skill. If any one nation can make a valid claim, it is Norway.

  • Comment number 37.

    All funding to the Scottish nhs should be dropped and if they want more coverage they should have to figure out how to pay for it instead of the English people having to support another perk to the scotts.

  • Comment number 38.

    I am dismayed to read comments like comment number 14, particularly the accusation that any non-British doctors working in the UK deliberately allocate better healthcare to foreign nationals. Having worked both in the UK and overseas, I have never seen anything to support this. I would hope that the writer of comment number 14 has checked their facts prior to making these allegations against the medical profession. Non-British doctors who come to work in the UK, just like UK doctors, are dedicating their lives to improving the lives of others.

  • Comment number 39.

    #38
    Where exactly does post #14 make an accusation that non-British doctors are distributing healthcare unequally to immigrants? Do immigrants who come to the UK without ever having contributed a penny in tax receive "free" healthcare in the uk? Yes. Are many of the trained medical professionals now employed by the NHS shamefully recruited from nations that need them more than ever so they can enjoy a better life and we don't have to bother training our own? Yes. The theft of medical staff from the developing world is probably the only reason the world would be better off if the NHS was disbanded. It is shameful. We should be exporting medical staff to the people who need them most. Not denying care to them.

  • Comment number 40.

    I can not believe Mark Easton is using source data that has been soundly ridiculed from all relevant academics. Is this the little englander slagging off Scotland again because the goverment in Westminster can not balance a budget to accomodate the population in England.
    In a nutshell the English NHS has a mandate for it's customers while the Scottish NHS has a mandate for patients.
    The Nuffield report and other sources you quote, employ invalid methodology resulting in ambiguous data.
    disappointing article fit for daily mail but not for the BBC.

  • Comment number 41.

    The premise of this story is mistaken. There has always been separate NHSes in England and Wales, Scotland and Northern Ireland. The confusion arises from English based and Anglocentric journalists confusing England and the United Kingdom.

    Now they're beginning to catch up, which is a Good Thing.

    The downside is that we are beginning to see the same sense of grievance from a certain type of English person that we in Scotland have had to become used to from the SNP. They believe that "The English" get everything that's going, if it wasn't for "The English" everything would be better, and so on. Now we're seeing English people with the same sense of grievance against everyone else, and it really isn't attractive.

    It's the same sense of grievance that informs moaning about "the Blacks" and "the Jews" or "the Poles" or whatever, and it has made politics in Scotland much more depressing and grim - especially since only about a quarter of Scots actually believe it.

    If English people want free prescriptions, they ought not to have voted for the Tories, but they chose to do so, and now they have no business trying to tell people in the rest of the UK what to do.

  • Comment number 42.

    Whenever there is any
    comparison between
    Scotland and England,
    someone (or more) Scottish comes rushing out to say they are not subsidised.

  • Comment number 43.

    This is evidence that the NHS is out of control. If they really knew the full cost it is unlikely that anyone would pay the charge.

    The fact is that everyone should pay something. Free lunches are seldom free and it is important that costs are identified. We cannot afford such largesse.

  • Comment number 44.

    @41 Mach A Seo

    What an excellent post.

    People in England should be more concerned about the fact that they're receiving a poorer service, rather than moaning about others receiving a better service.

    Voting for a party that is...shall we say "less sympathetic" to the NHS and the problems of the poorer citizen is also not wise if you want better services...

  • Comment number 45.

    43. At 09:24am on 4th Apr 2011, DibbySpot wrote:

    The fact is that everyone should pay something.


    ---

    And they do.

    It's called National Insurance, and it is intended to look after those in need.


  • Comment number 46.

    44. At 13:16pm on 4th Apr 2011, potatolord wrote:

    Voting for a party that is...shall we say "less sympathetic" to the NHS and the problems of the poorer citizen is also not wise if you want better services...

    ---

    ...which is one of the reasons the LibDems garnered so many votes last year.

    More fool them.

    But it is the sick now and in the future who will, quite literally, suffer for the ambition of Nick "Everything Must Go (including Party Principles)" Clegg.

  • Comment number 47.

    Should the "N" be dropped in NHS?
    As soon as you change any service between England and Scotland, the system us no longer national.
    It is "actional".
    Chance a few more letters, and you will have what I think of making insignificant changes that will disrupt one of the better NATIONAL HEALTH SYSTEMS in the world.

  • Comment number 48.

    "There will be some who regard the fact that NHS patients in England are now the only ones in the UK who might have to pay for prescriptions as evidence of unfairness."

    ---

    And there will be still more who will be aware that, as an England-only institution, the NHS has patients only in England (save for short-term visitors, treated under appropriate reciprocal arrangements).

    For emphasis, the "National Health Service" is England-only, with comparable entities in the other nations of the UK.

    Note - the UK is comprised of four NATIONS, and each of the four health services IS a NATIONAL health service.


    NHS Scotland, NHS Wales and Health and Social Care Northern Ireland are NOT part of the National Health Service!!!

  • Comment number 49.

    It would be helpful to understand how the NHS in Scotland is funded. Is it a consequence of the Barnett formula? If so the reason more is spent on the NHS in Scotland is in part because they are given more money to spend hence productivity is lower - and we all know how easy the public sector finds spending other people's money.
    If you have devolution you must learn to live with differences. So what? OK so prescriptions are free (actually they are not free, they are paid for by taxpayers and the nett result is a transfer of resources from well people to ill people. Some of the former are poor and some rich so there is a transfer from poor well peole to rich ill people. Interesting. In the university sector the argument for higher fees is 'why should poor people who dont go to university subsidise rich people who do! Compare and contrast with the NHS) but lets make sure we include ALL services because for example maybe some other service is available in England but not Scotland (certain cancer drugs maybe?).
    When oh when oh when are we going to get an ENGLISH parliament? No need for any expense. Simply pass a law that only English MPs are entitled to vote on measures which are devolved in Scotland, Wales, and NI. While we are at it, why are Scottish MPs paid the same as English MPs when a) the average consituency population is smaller so they have less work b) they cannot contribute to devolved legislation so they have less work - that legislation is paid for separately in the expenses of the Scottish parliament. Most of the above is no more no less than a sop to Scotland - a country actually I like very much - the unfairness to England is staggering, why no demos are organised for this beats me.

  • Comment number 50.

    Quoth Jacko - "It would be helpful to understand how the NHS in Scotland is funded. "

    Well if you look on the internet and spend some time working out how public services generally are governed and funded you would learn and then understand.

    Put the phrase "how the NHS in Scotland is funded" into a search engine and read the top ten articles. It will take a couple of hours but if you pay attention you may well understand, which is what you said you wanted! The website celebrating sixty years of the Scottish NHS is particularly useful.

    It's nice to know that you like us, Jacko - it would be truly heartbreaking to think that even one English person disliked us - but if you envy us our democratic settlement, one that we campaigned for over twenty years, why not campaign for a parliament for yourselves instead of whining that we have one and it's not fair!

  • Comment number 51.

    NHS = No Health Service, and from what I'm seeing it's only going to get worse.

    There is, and there has long been, a total lack of responsibility and, accountability.
    Governments paint pictures but the picture painted rarely reflects the reality because if it did, they would be out of a job.

    Putting GPs in charge of anything is a disaster waiting to happen. Here are just a few examples of their professionalism:

    1. Entered Drs surgery, my medical records file closed on blotter in front of doctor.
    In large red capital letters facing up towards that doctor were the words "allergic to penicillin". Outcome of visit - prescribed penicillin based antibiotic. Being a registered nurse I was able to spot her little mistake and ensure that it was corrected, but what if it had been a more 'normal' patient?

    2. On my way to work at local hospital I requested a Home Visit on behalf of wife who was "ill". Arrived home after work to discover doctor had visited, asked a few questions, told my wife it was a viral infection and then left. No examination. I left a message telling him to return and do his job properly. Result = inner ear infection discovered and treatment prescribed.

    3. During a lengthy period spent researching one particular disease and it's complications I discovered:

    a) Doctors do not listen to their patients.
    b) They do not take onboard what they are told by their patients.
    c) If at the time they are told something by a patient which they then regard as being irrelevant, there will be no record of what the patient told them - so that should the patient at a later date say, well I've told you that before....guess what!
    d) They 'apparently' forget things that have been known about for a very long time.
    e) They ignore the advice of their own experts, even when presented to them in printed, easy to read format, i.e.. a chapter from a medical reference book by a well known and long established British expert.
    f) They ignore the advice of others even more expert in one particular disease and the opinion of the Worlds leading expert (according to The World Health Organisation) - even after being presented with that opinion in black & white in the form of a letter. I went on to learn more later and I'm still learning, but I regret that I am unable to say the same for either doctors or British governments (Red or Blue).

    I do not want to be paying such people to be running our health service, at least in part because they have been involved in wrecking my own health, that of other members of my family and friends. But it does not stop there either, because they are doing it to you and your's too. Think arthritis as just one small example of a very significant complication of the disease I was investigating.

    Think too of the pain you and your's will be left suffering with - unable to get knee or hip replacement operations, 'when needed'.

    I particularly mentioned 'when needed' above for the simple reason that only you know how much pain you suffer, only you know and experience the effects it has upon your health and your lifestyle, your doctors perception of things will no doubt be somewhat different from your own - he/she does not feel your pain.

  • Comment number 52.

    The diffferences in Scotland, Ireland and Wales having regards to provision of health care are, to a large extent at least, down to the priorities of their own parliament or assemblies. It's how they choose to spend their money, and what they choose to subsidise with it.

    But please don't be taken in and think that we English need our own parliament or assembly too. Just in case you have not clicked on yet, they are only ways of increasing the numbers of politicians and so-called "public servants", thus ensuring more control and manipulation of the population - and higher taxation of course, much of which gets wasted and for which, no one appears to be accountable.

  • Comment number 53.

    I thought it was already unofficially called the World Health Service - where any British Citizen who has lived abroad for too long and not contributed in taxes, or foreigner who has never been to this country before, gets to claim free healthcare.

    How much more should the taxpayer need to shell out to pay for this mammoth of an organisation?

  • Comment number 54.

    We need a comprehensive world class NATIONAL health service, not a fragmented, for profit one. Be careful what you wish for, HEALTHCARE COSTS is the BIGGEST cause of HOMELESSNESS & BANKRUPTCY in the United States, 20% of the population have no health care at all and it costs around 20% more than it does here. Then there's the pre-exclusions & other insurance company getouts. It's no wonder we live longer here than they do there.

    My neice and her family moved to the US 10 years ago. The children suffer with bad teeth, all of them. A recent illness cost 40,000$US for gastroenterogy referral. When the eldest boy broke his collar bone they set it themselves with help on the internet, that's done a lot over there.

    I don't care about Andrew Lansley's ego. Let him be humiliated, he's got this wrong. The Tories are wrong too. They've wanted to privatise the NHS for a long time, we shouldn't let them get away with it. They have NO MANDATE from the people of this country.

  • Comment number 55.

    54. At 21:10pm 7th Apr 2011, diane wrote:
    They have NO MANDATE from the people of this country.
    ---------------------------------------------------------------

    Yep, keep trotting out the old party line. But try to remember that if you consider a true majority of the electorate voting for a party is what you think of as a mandate, we probably have not had a government that meets your approval since Lord Salisbury, when most people didn't have a vote. And Labour have NEVER had a mandate.

  • Comment number 56.

    In a way I feel quite sorry for the present coalition government given what it has inherited. Having said that however, there's not much to choose between them (political parties), in general terms they 'do not' listen - but they all use, and abuse.

    The NHS is a white elephant, it works for some - but not for others. It is I believe, wrongly focused, and should be switched to a system based on preventative health care. However for such a system to work effectively and efficiently requires not only the employment of suitable staff on the front line, but also experts at work behind the scenes, i.e.. scientists.

    If we take as an example of scientists, those who advised government about the BSE fiasco, it is very easy to see why failures might continue. After all, those eminent "experts" apparently stated that BSE could not jump the species gap. We are all animals, and humans are 'supposed' to be the most intelligent, but that is obviously a myth. Well, I mean, it was known at that time, that diseases could be passed from monkey to man! Well, it jumped the species gap/divide and in humans became known as New Variant CJD.

    Having recently read an article on the BBCs web site about scientists in relation to another condition which seriously afflicts significant numbers of mankind, I can only say that things have not, in my opinion, improved having regards to scientists.

    I therefore predict that mankind will continue to suffer because of their own kind, mankind being it's own worst enemy.

    Sorry about the doom and gloom - but have you ever tried to talk to idiots and get them to 'listen & learn'?

    I have, and my time, money and efforts were wasted by said idiots and those they employed, all of whom are funded by you and I.

  • Comment number 57.

    It should drop the S as well

  • Comment number 58.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 59.

    There is a bigger difference between London and four of the English regions than there is between London and Scotland.
    Why are the East of England, The East Midlands, the South West, the South East all subsidising their capital to such a huge extent?
    Or does that not make such a nice shock-horror story as the anti-Scottish one.


  • Comment number 60.

    "5. At 18:49pm 1st Apr 2011, Edward2010 wrote:
    I find this completely hilarious at the English reaction to this story. Mostly all ill informed. Not really helped by a bias and uneducated media, whose main objective is to stir up as much reaction as possible. I recomend that the English do some growing up and start questioning their own MP's to the real reasons as to why they cannot have free prescriptions. The fact that English tax payers DO NOT subsidise the other devolved Nations, should also be highlighted instead of being buryied by the media"

    Get real mate. Scotland has 5 million people in it. England has 60 million people. 60% of britians income to the government comes from the london banking sector.

    Scottish ministers have the power to vote on issues that only effect english taxpayers and they do so in order to usurp any policies that might take away money form scotland. Yet English ministers do not have the power to vote on issues that only effect scottish tax payers.

    So it is pretty obvious english tax payers are heavily subsidising scottish tax payers to the tune of free prescriptions and free university education whilst we do not have the same privelledges.

    And the reason is that it would be impossible to afford to pay for that for 60 million people but 5 million? Pretty easily.

    Its not fair and its dishonest but because of the low life runing things up in scotland english tax payers are getting fleeced.

    You know it and i know it, deny it all you like but basic maths proves this to be true.

  • Comment number 61.

    Try livimg in Europe or the USA and see how you get on when ill

  • Comment number 62.

    Divide and rule indeed. The United kingdom has always been a thorn in the side of Europe - it broke away from their Catholic Empire and has been independent, and also more prosperous, ever since. I suspect that many Europhiles desire to see the UK broken and divided and that they have exploited the dream-like nostalgia of the Welsh and Scottish nationalists for this purpose. When will these nationalists wake-up and realise that divided we are weak. On the other hand, maybe we should complete what they have begun and ban Welsh and Scottish MPs from sitting in the English parliament - fair is fair after all. The English should not allow themselves to be abused by the traitors in Westminster.

  • Comment number 63.

    Devolution is a really, really stupid idea! The disparities between the English, Scottish, Welsh and N. Irish health services make it obviously so. Personally, I consider myself to be British, and it's about time the rest of you did. Failing that, let's reinstate the borders, collect our own taxes, form our own armies, and fight each other to the death like the good old days! Devolution is regressive and suggests that we humans are no where near as advanced as we think we are!

  • Comment number 64.

    Of course Scotish have everything, no business tax, no prescription charges, free tuition fees, health care for the elderly, they are arian arnt they, not that I resent them anything good luck to them brilliant.

  • Comment number 65.

    Re: my#58.
    :
    In this post which was removed by the BBC who 'claim' it broke their rules, I was replying to post #57 by xipde.
    :
    It appears that the BBC do not like the truth being aired in public. The reasons provided by them for it's removal do not add up - particularly given that I can prove what I stated about one particular hospital and it's staff that I mentioned.
    I have copies of part of my health records (just as well that I obtained them before they were computerised). In those records are the comments made by staff at the hospital. Further, having regards to "there being no connection between my condition and my low back pain and stiffness" - I hold proof that such a connection had long been known to exist - and prior to that, since it was referred to in a well-known and long established Medical Dictionary.
    :
    Are we therefore to understand that the BBC no longer supports the truth or the British public and their dependancy on the NHS for the provision of a satisfactory standard of health CARE!
    :
    Could this have anything whatsoever to do with the appointment of a new DG?
    :
    Long may they remain independent of government..........

  • Comment number 66.

    Should the NHS drop the 'N'?

    Absolutely not! Imagine the NHS as HS, more prefixes come to the for - SHS, WHS, BHS and so on, the NHA is the National Health Service and should remain so.

    Any costings gone into this excersize of dropping the 'N' I wonder? I expect not, it would just come out of the budget for the NHS along with the 'Private' company supposedly overseeing the GP's handling of the funding - more hyper saleries and even bigger bonuses! Just an excuse for 'Jobs for the (Camerons Cronies) Boys', which will ultimately result in a much poorer and divided National Health Service, where patients will have to pay twice for their treatment, once through National Insurance and once to the 'Private' controller of Funding for the NHS - It will not so much be an improvement, as a breaking up of the NHS - likely to be 'American Style' health insurance based, just to ensure the working people cannot keep any of their hard earned money, that it all goes to the Rich and Privaleged of society.

  • Comment number 67.

    The actual excuse for removing my post #58:
    :
    Dear BBC blog contributor,

    Thank you for contributing to a BBC blog. Unfortunately we've had to remove your comment below.

    Comments on the BBC blogs will be removed if they contain material that is potentially defamatory.
    :
    Ah! so, my comments were 'potentially defamatory'. Perhaps the BBC will excuse me for saying this but given that they are an organisation which exists off the backs of the public, entirely supported by involuntary public donations, one might expect their 'journalists' to check out public interest stories! Well no, apparently not - particularly if they involve government.
    :
    In that missing post I also mentioned a specific disease, and the difference in attitudes to it between The World Health Organisation and, The British governments. Oh dear!
    :
    Given my interest, lengthy personal experience and expertise, I might have thought better of the Beeb had they bothered to explain exactly what it was they believed to be potentially defamatory.
    :
    Chris Patton for DG!
    They'll be safe in his hands........
    Not that I've got anything personal against the man of course - just that he's a former senior politician, governor of Hong Kong and now obviously needs/wants another nice little earner!

  • Comment number 68.

    NO! that is just what they want us to do.let us,in england demand free persription along with free dental care for our people,for gods sake stand up to them!!!!

 

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