Here’s what a King’s Fund research report told us in 2013, four years ago:
- Scotland, by contrast [with England], has abolished all vestiges of the ‘internal market’. (11)
- There is relatively little cross-border flow of patients from Scotland to England. (11)
- Scotland specifically embraces a philosophy of ‘mutuality’ between the Scottish people and the NHS. Internally it has a highly developed approach to partnership working between the trade unions and management. The partnership’s remit stretches well beyond terms and conditions to broader issues such as quality and the design of services. (11)
- Scotland has a long and honourable tradition of clinical audit that over the years, both before and after devolution, has helped inform the approach of the other countries. (11)
- Scotland appears to have made more progress [in developing integrated care], perhaps in part due to its relative organisational stability over the past decade (11)
Now we have the Nuffield Trust telling us a very similar story four years later. Here are the key positive points:
- Scotland has a unique system of improving the quality of health care. It focuses on engaging the altruistic professional motivations of frontline staff to do better, and building their skills to improve. Success is defined based on specific measurements of safety and effectiveness that make sense to clinicians.
- Scotland’s smaller size as a country supports a more personalised, less formal approach than in England. The Scottish NHS has also benefited from a continuous focus on quality improvement over many years. It uses a consistent, coherent method where better ways of working are tested on a small scale, quickly changed, and then rolled out. This is overseen by a single organisation that both monitors the quality of care and also helps staff to improve it.
- While comparing performance is very difficult, Scotland has had particular success in some priority areas like reducing the numbers of stillbirths. Scotland’s system provides possible alternatives for an English system with a tendency towards too many short-term, top-down initiatives that often fail to reach the front line. It also provides one possible model for a Northern Irish NHS yet to have a pervasive commitment to quality improvement, and a Welsh system described as needing better ways to hold health boards to account while supporting them in improving care.
- While Scotland also faces particular issues of unequal health outcomes and very remote areas, there are pioneering initiatives to address these, and should be considered in other parts of the UK facing similar issues.
- Scotland has a longer history of drives towards making different parts of the health and social care system work together. It has used legislation to get these efforts underway, while recognising that ultimately local relationships are the deciding factor – there is much for England and Wales to learn from this.
Now, I feel sure Ruth Davidson and Kezia Dugdale didn’t see the King’s Fund report, judging by their ill-informed criticisms of NHS Scotland over the last few years. Will they pay attention to the Nuffield Trust report, recognise the achievements of NHS Scotland and consequently its management by the SNP government? If it was the other way around, they’d be quick to blame the SNP for ‘not getting on with the job’, so?