of all. Health is determined by a complex interaction of social, economic and personal factors. Its causes are not straightforward. Health is marred by inequalities, for example, the type of housing and area people live in, household income and social expectations. Interventions likely to improve public health will require a combined package of social, economic and health policies.
Therefore, securing good health for the whole population means co-ordinating policy across and between government departments and also between the UK and devolved governments.
The NHSiS has one major attribute that UK politicians need to build upon. We have one
Jul/Aug 10
less major tier of management (SHAs) but Scotland has the same mixed economy of clinicians, managers, medical royal colleges, civil servants and politicians. The main difference in Scotland is that all speak to, not at, one another in a spirit of cooperation.
Partly due to the size of the country, lines of communication are far shorter and, dare I say it, the relationships we have seem to be founded on a mutual respect derived from actually knowing each other. Creative tension is the norm – not a constant war of attrition from entrenched positions.
Yes, health policies are
increasingly diverging across the UK - but this is an opportunity. By implementing different
approaches in healthcare delivery we are in effect testing different models. Which delivery model is best for patients? Only time will tell.
There is one further aspect of this whole debate that I believe needs to be aired – and that is the position of professionalism within the NHS, whether that be in any of the four home nations.
I have seen enormous changes during my 36 year career as a rural general practitioner – the job I do now is far more challenging than the one I started as a young doctor. I have been through the 1990 contract, trusts, unitary health boards, markets, fundholding, purchasers, providers, local health care co- operatives, community health partnerships, areas, divisions,
units and many other passing enthusiasms of fashionable health pundits. But one enduring building block remains – the one-to-one relationship between members of my clinical team and individual patients.
Above all I want a generation of politicians that will recognise that fundamental relationship – and seek to cherish and foster it and to realise that what drives clinicians is not targets, rules, sanctions or contracts – but the professionalism that underpins the doctor/patient relationship. If we achieve that in the life of the next parliaments – at Westminster and at Holyrood - we will have done more for Scotland’s patients than we ever dreamed possible.
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