Why even in deep distress NHS England cannot learn from its nearest neighbour, Scotland


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?


16 thoughts on “Why even in deep distress NHS England cannot learn from its nearest neighbour, Scotland

  1. Bugger (the Panda) February 4, 2019 / 12:39 pm

    They are also fighting crocodiles, sharks and poisonous snakes daily in their ever decreasing politicised funding.

    Their horizons are focused daily on surviving.

    Bit like the way Theresa May lords it over Parliament and the Citizens.

    Daily headlines and soundbites.

    Long term thinking never mind planning hasn’t a chance in NHSE

    Liked by 2 people

    • Bugger (the Panda) February 4, 2019 / 12:42 pm

      Permanent Crisis Management.

      Never mind Uncle Sam in the person of Kaiser Permanente will ride to their aid with money and private health insurance.

      Liked by 2 people

      • gavin February 4, 2019 / 1:16 pm

        Donald’s orangepeel dayglo skin?

        Down to “good genes” apparently.

        Liked by 2 people

  2. gavin February 4, 2019 / 1:13 pm

    Never mind. After Brexit, Boris & Co assure us that all will be well when Johnny Foreigner is sent packing.
    £350 million a second for the NHS. Or more, much more, in old money.

    “England” for the English. The old certainties, Queen, country and flag— and remember to doff your cap to your betters.
    Beating the colonials at cricket and rugger.
    A land fit for Eton and Bullingdon Boys. What could be more splendid, old chap!
    Hip, hip hoo………………………………………………..

    Oh wait. I think I see a Unicorn at the door…..wearing a Vote for Ruthie hat!

    Liked by 4 people

    • Contrary February 4, 2019 / 1:37 pm

      Watch out Gavin, I think you might have caught something during one of those infectious outbreaks…

      Liked by 1 person

      • Gavin February 4, 2019 / 4:05 pm

        I have a wee touch of Hysterical Skeptica Syndrome.
        Doc says itll pass by the end of March.

        Or maybe not…………

        Liked by 1 person

      • Contrary February 4, 2019 / 4:53 pm

        well, if you start yelling ‘Tally ho!’ in public,,, I’d go back to have a wee chat with the doc 😉

        Liked by 2 people

  3. Contrary February 4, 2019 / 1:47 pm

    But but but

    Radio Scotland GMS telt me this morning that

    a PORTER was caught carrying a rubbish bag out to the bins while NOT WEARING GLOVES – right next door to where premature babies in safely sealed wards and incubators are lying innocently sleeping. So, according to the BBC, this is obviously the problem with completely unrelated infections being spread. Sigh. So they had a doctor on, head of childrens treatment or something, who sighed as well, and was fairly exasperated at the complete ignorance and barefaced numpyism of the reporting team – honestly, GMS actually said to him that that must be a risk – he said, no that was not clinical waste, they had the proper PPE for each type of waste disposal, porters do not go anywhere near the wards anyway, and any of the waste does not carry the same bacteria as that found in infections, and he was not in charge of waste management so could not comment on if any changes needed made, he was a doctor and could only state again that the waste disposal would not put anyone in the hospital at risk.

    Gloves. Someone is going round taking photos of people taking the bins out and have found… horror or horrors! EVERYTHING is in order and they are following procedure correctly. So which numpty reported on this without checking out what the different colour of bin bag meant?

    Liked by 4 people

    • Alasdair Macdonald February 4, 2019 / 2:31 pm

      This was a dog-whistling piece which is based on the ‘production values’ of BBC Scotland News and Current Affairs – it had appeared in one of the newspapers over the weekend, therefore it had to be included since it is the predominantly unionist press which determines what is on GMS. This piece was also a trailer for the fact that the staffing plan to be published by the SG has been delayed – YET AGAIN, was stated portentously. And this, in turn led to a report about a ‘possible’ lack of provision in Wick.

      I had thought that with the alarmist over-the-top stuff relating to pigeon shit and the deaths of premature babies resulting in a much more measured piece, by Ms Lisa Summers, at the end of last week which sought to put the reports into perspective and to calm public fears, that this thing was settled, but clearly the unionist polling returns suggested that the fear had to be cranked up again, so we had the porter story, the staffing review and the shortages in Wick. NONE of these is actually given space on the BBC website.

      Liked by 3 people

    • Contrary February 4, 2019 / 8:51 pm

      Very interesting that these stories didn’t appear on the website – less evidence of their use, and the wider non-Scottish population less likely to access them.

      Truly incredible, that story about the staffing plan from the scotgov being delayed (dramatic pause) AGAIN. The bin bags thing though, it was just unbelievable, the doctors and staff being interviewed for all these non-stories just sound so depressed, they must have such an awful time trying to comfort and keep morale up for parents of premature babies, to have this kind of irresponsible reporting must be having a huge strain. I can’t even imagine how devastated the parents are feeling. And for NO REASON – the BBC haven’t found anything untoward, they haven’t investigated anything, there are no unusual happenings, and they are talking about things – informing the public – about things they have no understanding of. They have no shame, no conscience and no compassion. I really am totally disgusted by this latest attack.

      Liked by 2 people

  4. Bugger (the Panda) February 4, 2019 / 1:52 pm

    Fox and NHS Officials and Civil Servants have visited Kaiser Permanente in N California to see what solutions they could offer.

    No truth in rumour the Fox has already negotiated his %

    Liked by 2 people

    • Bugger (the Panda) February 4, 2019 / 4:33 pm

      His log on money


  5. Scott February 4, 2019 / 7:30 pm

    I suppose you have seen RS tonight main stories SNHS more SNP bad and there is going to be another tomorrow they must have ran out of SR bad.

    Liked by 1 person

  6. Ludo Thierry February 5, 2019 / 8:39 am

    After all the beeb Scotland ESSENNPEE/Scotland Baaaaaaaaaaaad stuff here is a wee bit of good stuff from news.gov.scot regarding Community Payback Orders – John carried a report last week (I think) but National Stats Scotland put some more meat on the bone info yesterday – snippets and link below:


    Community sentences continue to support local projects across Scotland.

    Justice Secretary Humza Yousaf has welcomed figures revealing Scotland’s communities have benefitted from around 7 million hours of unpaid work by people serving Community Payback Orders since their introduction in 2011.

    Criminal Justice Social Work 2017-18 statistics show 17,800 Community Payback Orders (CPOs) were commenced in 2017-18 and 75% had an unpaid work or other activity requirement. (eg gritting paths and pavements – reducing falls and attendant injuries and admissions to hospital)

    In addition, just over 1,000 fiscal work orders commenced in 2017-18 including unpaid work and 86% were successfully completed.

    Responding to the figures, the Justice Secretary also confirmed plans to lay the order to extend the presumption against short prison sentences from 3 months to 12 after Easter. Subject to parliamentary approval, it is anticipated the extension will come into force in the summer.


    Criminal Justice Social Work Statistics in Scotland: 2017-18

    6,887,119 of hours of unpaid work have been recorded as part of CPO unpaid work or other activity requirements successfully completed between 1 April 2011 and 31 March 2018. It doesn’t include unpaid work under legacy orders, fiscal work orders or CPOs unpaid work requirements that were not successfully completed.

    The use of custodial sentences under 3 months has fallen over the last decade, while the proportion of people given a community sentence has risen, from 14% in 2008-09 to 20% for the last two years.

    85% of the responses to the Scottish Government’s 2015 Consultation on Proposals to Strengthen the Presumption against Short Periods of Imprisonment supported an extension of the presumption and 84% supported an extension to 12 months.

    National Statistics show that those released from a short prison sentence are reconvicted almost twice as often in 12 months than those given community payback orders (CPOs).

    Justice Social Work plays a vital role in ensuring community sentences and other interventions are effective in addressing offending and its causes, paying back to communities and preventing re-offending. This work has helped achieve a 19 year low in reconviction rates.

    Completion rates for community sentences have increased, 70% in 2017-18 compared to 64% in 2006-07. (Note = the period of the SNP Scottish Govt)

    Updated Practice Guidance on Community Payback Orders was published on 25 January to further support effective practice and improvement, including a fresh focus on breach and compliance.

    While volumes of criminal justice social work reports and orders fell by over 5% in the last year, ring-fenced funding for Criminal Justice Social Work of just over £100 million is being protected in the 2019-20 Budget to deliver community sentences, support rehabilitation and reduce re-offending. (ie more resource can be devoted to each case optimising potential outcomes).

    The Scottish Government continues to invest in third sector services that support criminal justice social work and community justice partners working together, to reduce reoffending. In 2018-19 this investment totalled over £11.6 million including support for mentoring, Apex, SACRO, the 218 Centre for women, Venture Trust, Turning Point Scotland, Families Outside and Prison Visitor Centres.


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