AudioNick Timmins and Catherine Foot: the four UK health systems
Catherine Foot speaks to Nick Timmins about his new paper on the four UK health systems. Nick discusses the similarities and differences between the health systems in England, Scotland, Northern Ireland and Wales, and the difficulties in comparing and contrasting the impacts of each system.
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I was involved in running integrated care workshops in south wales a few weeks back and despite the lack of purchaser-provider split, despite the presence of regional health boards funding all local health services, the issues raised by the group could easily have been any health economy in England. Too many older people with complex needs and frailty defaulting into high cost acute settings and staying too long for want of investment in prevention or responsive support outside hospital or capacity in step down services, different organisational values, language and priorities, poor use of shared information and trusted assessments, difficulties in cost shifting from buildings to services etc etc. And it is telling that if anything the performance of the English NHS post devolution appears to have been more efficient than that of the devolved nations. One thing i am fed up of is the tariff being blamed in England for all the system issues, as if hospital doctors like me (I saw 53 acute admissions on sat between 8am an 8pm, sending 22 back home again from the front door - not atypical) are busy admitting patients to generate tariff income for the trust when we are in fact desperate for beds. If tariff is the problem then how come we have such major variations in admission rates and bed occupancy within England and how come in the devolved nations who have scrapped the purchaser provider split they still face the same set of issues. It is but one small part of the range of system solutions but it is an easy target. "For every complex human problem there is a solution which is simple, obvious and wrong" HL Mencken.
I also think we have a second natural experiment which is transforming community services policy. English community services are now being run by a mismash of acute providers, mental health trusts, social enterprises etc - but which model will produce the best outcomes? I have my hunches...David Oliver
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