NHS Confederation Chief Gill Morgan has claimed that devolution of Great Britain has given rise to a National Health Service that operates under four different systems.

While the underlying principle of free healthcare for all, the core value of the Service since its inception in 1948, remains unchanged, the NHS is now in a “unique position” in that it offers patients different services depending on which country they live in, she told the BBC. Devolution has broken down the once universal system across the UK, leading to a “complete split in philosophy”, she said.

The differences in what services patients can expect to get in the different nations are certainly marked, and further cement the current postcode lottery of care. In England, the NHS has turned towards offering choice to improve care; the door has been opened to external organisations to compete for service provision, and patients can cherry-pick services. But this model has been “rejected by the other three," Morgan explained.

In Scotland, private sector involvement is much scarcer and nursing care is free, but waiting times are longer. In Wales there is a strong emphasis on public health and prescriptions are free, while, in Northern Ireland, health and social care have become much more integrated.

But, while Morgan insists that each system has its advantages, patient groups have warned that the differences are “breeding envy” among patients.

Speaking on BBC Radio 4’s Today programme earlier this week, Michael Summers, vice chairman of the Patients’ Association, said that England was the “poor relation” in terms of the healthcare provision in other UK nations, and he called for all patients to receive free prescriptions, according to media reports.

Growing differences
Morgan, however, believes the differences between the four NHS models will likely continue to grow, as each nation focuses on its particular needs. As one example of this, the Scottish Executive announced plans late last year to abolish all prescription charges by 2011, in a move borne out of its commitment to build a healthier nation by “tackling health inequalities” and “supporting people to live longer and lead healthier lives”. In England, however, patients are now paying £6.85 per prescription, following another hike in price in early 2007.

Summing up the current situation, Joyce Robins of Patient Concern told the BBC: "Patients are increasingly looking across national borders and wondering why they are not getting the care others are getting…I am not sure that is good for the NHS."