Scots NHS inferior to England and needs radical surgery – think tank – The Scotsman


Lyndsay Moss, The Scotsman, 10 April 2009

Health services in Scotland lag behind other European countries – including England – and radical reforms are needed to improve care for patients, a think tank claimed yesterday.

Reform Scotland called for a legally binding NHS charter so patients know the treatment to which they are entitled.

It also proposed greater competition between health providers – including private sector involvement – to increase choice for patients, and the scrapping of centrally imposed targets.

However, opponents claimed the proposals would lead to a "two-tier NHS".

The Reform Scotland report said, despite increases in life expectancy, waiting time improvements and reduced mortality rates, "Scotland compares poorly with other European countries, including England".

The think tank said central control and management of the NHS and centrally imposed targets had not delivered good value for money. This was despite a 55 per cent rise in health funding in a decade.

It said other European nations with the same ethos of healthcare, free at the point of need, provided a greater choice of services to drive up standards. Countries such as Denmark and Sweden had systems in which decisions were made locally, giving patients more power.

England was also singled out for praise for giving patients a choice of hospitals and allowing private sector involvement to boost competition.

Another recommendation was to axe waiting time targets, with local managers and clinicians given more freedom.

Geoff Mawdsley, director of Reform Scotland and one of the authors of the report, said they recommended the creation of an NHS constitution to define patient entitlement to care.

The report also said patients should be able to take out supplementary insurance for treatments not supplied by the NHS.

Reform Scotland proposed changing the role of health boards, removing their part in providing care and making them the commissioners.

Hospitals and other healthcare providers would become independent of the boards and would be commissioned to provide the service. This would leave the path open for private sector providers to bid for business.

Jackson Carlaw, public health spokesman for the Scottish Tories, said: "We have long argued about the dangers of a target-driven system, with centrally set objectives warping local clinical priorities. We need to remove outdated and irrelevant political dogma."

But Liberal Democrat health spokesman Ross Finnie said the report was "nothing more than a playbook on how to privatise the NHS in Scotland".

He added: "It calls for patients to be given a right to opt out of the NHS and top up their healthcare with insurance payments if they can afford to do so," he said. "This will lead to a two-tier system that will be ultimately detrimental to patient care."

The Scottish Government said: "We believe healthcare should be free at the point of delivery, regardless of a patient\’s circumstances. We continue to uphold the founding principles of the NHS."


• Replace NHS boards with "health commissioning co-operatives", which would commission services for patients.

• Introduce greater competition between healthcare providers – public, voluntary and private sector – to drive improvements.

• Scrap centrally imposed performance targets and give local NHS managers and doctors greater freedom to improve services.

• Bring in supplementary insurance, allowing patients to secure treatments and drugs not provided by the NHS.

• Create a legally binding charter setting out the care and treatment patients are entitled to receive from the NHS.