There are two reasons why NHS England & Wales cannot learn from the obvious source of good ideas, its nearest neighbour, with which it shares a border, exchanges staff and patients on a regular basis and which often shares research funding.
The first is a mix of ignorance and contempt. Many powerful and influential English politicians, academics and health managers, sharing similar backgrounds, have a long-learned habit of looking to the USA or Australia or sometimes even mainland Europe for comparison and, perhaps, lessons they can learn. A generalised perhaps semi-conscious sense of superiority over their Celtic neighbours has long led them to look elsewhere. That could be changed. The London-based Nuffield Trust seems not to suffer from these restrictive attitudes, as we’ll see below, but it is an exception.
The other reason is almost certainly insurmountable. NHS England and NHS Scotland are products of wider cultures with long roots. Though from a global perspective not wildly different, Scottish society, politics and thus institutional development is a bit more collaborate, consultative, non-interventionist and collectivist while that of England, especially in it’s culturally and politically dominant and affluent South-East, is more competitive, authoritarian, interventionist and individualistic. Indeed, leading figures from the dominant Tory elite are openly contemptuous of Scottish society, seeing those same traits as weak, passive and socialist. The latter term is of course an unquestioned negative for them. So, even if they were to look north, they would see nothing to be admired or, heaven forbid, copied. Regardless, even if they wanted to, copying the reasons for NHS Scotland, would be almost impossible. They’d have to launch a, minimum, 100-year plan with the aim of transforming all of English society into a less competitive, less authoritarian, less interventionist, less individualist, form. They’d need population transfers with other countries on a massive scale, swapping the more self-centred for the more community-minded souls. I suspect even Stalin would have said ‘can’t be done, give up.’
More below on NHS Scotland, from the Nuffield Trust. First see this from the generally high-quality Open Democracy:
It’s a perceptive analysis correctly identifying the need for cultural change, but sadly just as Anglocentric as commentary from more right-wing sources. There is no mention of Scotland at all despite OD’s regular pieces on Scottish matters. Unlike the Nuffield Trust, 18 months earlier, they miss these essential thoughts, including, admittedly, some that could be copied:
So, 18 months after the Nuffield Trust suggest NHS Scotland’s ‘unique system of improving the quality of health care’ offers ‘much for England and Wales to learn from’, they have ignored or just missed the recommendations and instead turned back to the Neo-Stalinist, top-down, ten-year plans that always fail. Sadly, though they might do well to copy some things including certainly meddling less and trusting more, I doubt they could make much of a difference in a system so deeply embedded in its surrounding and mostly unchallenged matrix of essentially Tory values and attitudes.
So it goes?