Derek Feeley: what are the differences between the English and Scottish health systems?

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  • Posted:Wednesday 09 January 2013

Derek Feeley, Chief Executive, NHS Scotland, highlights the similarities and differences between the Scottish and English health systems. One of the biggest differences is the focus on integration and collaboration in Scotland, compared to the focus on competition and choice in England. Derek also introduces Scotland's 2020 vision, which aims to shift the balance of care from acute settings to the home, and the balance of power to patients and carers.

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Roger Livermore

Comment date
06 April 2013
My enquiries are continuing but there are apparently major differences in regulation in Scotland relative to England, Wales or Northern Ireland. Unlike the rest of the UK, NHS Scotland does not have a regulator and certainly not an independent regulator. I have written to the minister. Healthcare Improvement Scotland (HIS) have now confirmed in writing that, contrary to ministerial assertion, they are not a regulator for the NHS, indeed they are part of the NHS and so cannot be. HSE has a small and reluctant role as confirmed by a Letter of Understanding with HIS. Patient treatment is partially subject to the Health and Safety at Work etc Act 1974 but is not actively used. The Act's application could prevent about 35% adverse incidents in Scotland, its methodology could prevent about another 50%. However he Act is not used in proactive work, and not reactively in incidents except in extremely rare situations. The Francis Report also majors on this as part of the 'regulatory gap' in England, Scotland is different it has a 'regulatory chasm'. I am in touch with the inquiry team. NHS Scotland may be unique in all the UK in it being a business which is de facto exempted from the Act, and on an extremely important aspect, this by virtue of the Letter of Understanding. I am verifying whether the agreement is legally valid; eg it may not be in HSE powers to exempt the NHS in Scotland from regulation.

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