|
UK |
England |
Scotland |
Northern Ireland |
Wales |
Political context for
health policy |
The Lothian question
remains. A return to
Westminster government
by the Conservatives
would raise further
concerns.
Westminster Health
Committee concentrates
on England.
Health remains a key
political issue.
A sense that the
increased resources have
not let to commensurate
improvement. |
A resurgent Conservative
Party places pressure on
Blair government to
speed reform, while also
facing a internal
discomfort over private
involvement and
the threat of closure
for ‘failing’ units. |
Government pressure
mostly from the left.
Weakening political
pressure to retain policy
direction of English.
Move to local service
provision according to
needs.
Active policy community
with involvement of
doctors and medical
universities/colleges.
Public engagement
with consultations. |
Assembly suspended;
Northern Ireland Office
in charge.
Service redesign needed
but health policy not a
key issue; defence of
hospitals is.
Politicians take a
parochial view of health
services. Weak health
policy community.
Health designated as an
area of cooperation with
the Irish Republic. |
Health Minister Dr Brian
Gibbons is focused on
delivering ‘Designed
for Life’.
Some calls to adopt
some English reforms
have been silenced.
Weak policy community.
Focus on deficits,
hospital closures, role of
the Health Commission
Wales, NHS waiting
times, GP recruitment
and retention,
community hospitals. |
Strategic direction
of health policy |
Redesign service
provision.
Reduce waiting times.
Better manage demand.
Increase productivity.
Make efficiency gains.
Case management of
long-term conditions. |
Quick access, speedy
treatment.
A bewildering policy
programme with many
strands, based on
strengthening markets
and management.
Making services
responsive to a
consumer culture.
Quasi-market
competition. More
points of treatment
and better information
to support choices. |
Creating a more
integrated health system
with close connections
between different
components.
More community
based care.
Strengthening clinical
networks, providing
seamless care. |
Developing links with
local government.
Strengthening of
commissioning to shape
health and social care.
Prescribing policy is
being developed to
address the Appleby
Review finding of
low productivity levels.
With Assembly, it will
be difficult to make
progress on difficult
decisions on service
redesign. |
Concentrate on the
social environment and
the causes of ill-health.
Designed for Life sets
out a strategic intent to
change services and
tends towards the
Scottish model more
than the English. |
Changing
organisations |
There is a common aim
across the UK to
redesign services, but
this plan is being
approaches in different
ways. Policy is more
developed to achieve
this in England and
Scotland than in Wales
and Northern Ireland. |
DH to play less of a
direct steering role and
StHAs to become the
DH in regions.
Creation of elective
centres. Private sector
encouraged to tender
for NHS contracts.
Healthcare Commission
monitors quality. Lack
of a market regulator
in the system
governance. |
Executive manages NHS
Scotland. NHS Unified
Boards.
NHS Quality
Improvement Scotland
gathering performance
data.
Concentrating specialist
services in key centres.
Some private capacity
to be employed.
Developing services
outside hospitals. |
A new single health
authority with local
offices that will
commission within
Council boundaries.
Beginning to review
how to proceed with a
medium term plan to
concentrate acute
services and building
a network of supporting
services around them. |
Public health moving
toward supporting
the commissioning role.
Acute trusts are large
compared to small
health boards that have
little power to shape
hospital behaviour.
Health Inspection Wales
responsible for
monitoring healthcare
standards and efficiency.
It is answerable to the
Welsh Assembly. |
Changing financial
flows |
A slow down in the
funds allocated to health
and social care.
Questions about the
value for money in NHS
spending.
No pressure to review
the Barnett formulae. |
All providers to face a
new tariff regime with
money following patient
choice.
PCTs in debt face
incentives to provide
care away from
hospitals.
Doctors have more
opportunities for
non-NHS work. |
First minister says goal
is to reduce spending
per head in line with
England.
Free personal care for
the elderly is costly and
leaves less money.
Tariffs will be developed
for some elective
procedures. |
Key questions on value
for money.
John Appleby (chief
economist at the King’s
Fund) has drawn
attention to the lowest
productivity in the UK. |
Prescriptions are
provided for free by
April 2007.
School breakfasts are
provided for younger
children. |
Changing relationships
with professionals |
A common view that
wages have consumed
a large proportion of
increased resources.
A view that changing
working patterns need
to be adopted.
Use of incentives –
through QoF – to guide
GP behaviour. |
Doctors seen as ‘knaves’
rather than ‘knights’.
Policy makers plan to
make greater use of
incentives to shape
clinical and
organisational behaviour. |
The broad policy
direction has been
established with the
input of the profession.
Campaigns at the local
level to ensure
distribution of services
according to patient
need led by doctors. |
One Patient Client
council to represent
interests of the public.
Changing ways of
commissioning and
devolution of
commissioning form
top down.
A focus on productivity
will bring sharper focus
on ways of working. |
A 2005 poll of health
professionals found
most would not want
their family to be
treated by the NHS in
Wales.
Uniquely, within the UK,
public health has been
concentrated into a
single agency.
Health minister is a GP
and former GPC
member. |
