What drives the NHS?

To the Editor: In their amusing Postcard from the UK, Jamrozik, Heller and Weller1 paint a picture familiar to most of us in the National Health Service (NHS), but, as with most art, some licence has been permitted. Comparing the size of the UK NHS workforce with that of the Chinese army is unfair: there are, as they know, four different health services in the UK (England, Scotland, Wales and Northern Ireland), which function separately and distinctly.

The NHS Jamrozik et al describe is much more the English model. In Scotland, targets for cancer care have been set, although they will not be applied for over a year yet. In the meantime, NHS Scotland has awarded the three Scottish regional cancer networks an extra £25 million (A$62.5 million) to improve and enhance agreed cancer services to assist them achieve the agreed targets on waiting times, etc.

Another example of the difference between the Scottish and English NHS can be found in the detail of the new consultant contract. Scotland is offering its consultants a sabbatical and England does not. I am reliably informed by one of the negotiators that the seed of that idea was sown by me when I was recounting enthusiastically some of the better experiences of working in Australia’s own, if complex, national health service.

Finally, those of us who laboured during the 1990s at the coal face of Victoria’s health service will not be unfamiliar with targets. Infringement of targets set for the upper levels of the waiting list (no one in Category 3 could ever expect treatment, so no target was set), and for 12-hour waits in the emergency department, carried huge financial penalties for the institution. The good old NHS is far from unique in its fondness for targets.