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Published: 10/04/2003, Volume II3, No. 5850 Page 12 13

In three weeks, Scotland and Wales will go to the polls for their second elections since devolution. Jennifer Trueland scrutinises Edinburgh's track record on health since 1999 and examines the manifesto commitments of the main parties. Next week: Wales

The first four years of devolution in Scotland have certainly been eventful. Since MSPs took their first oaths of allegiance, they have seen three first ministers, passed 62 bills, submitted or answered 35,000 written questions - and watched the price of the Parliament building spiral from£40m to almost 10 times that.

The health arena has been particularly busy. It has seen the introduction of free personal care for the elderly; Scotland's NHS plan, Our National Health - which alone contained more than 250 pledges - and most recently the white paper Partnership for Care, which sets out the final steps to dismantle the internal market.

But what has devolution actually meant for the health service in Scotland, and how far have health services north of the border diverged from those in the rest of the UK?

Dr John Garner, chair of the British Medical Association's Scottish council and a GP in Edinburgh (and an Englishman to boot), admits he voted against devolution in the 1997 referendum. Now, however, he believes it has brought benefits. 'I was quite anxious about it - about the separation aspects. But over the four years I've seen a real maturing of the Parliament and I think it is right for Scotland.

'We have gone our own way on funding free personal care and promising compensation to people who contracted hepatitis C through contaminated blood products. There is a danger that if the revenue stream from the Barnett formula [which funds Scotland at a higher rate than England to account for rurality and deprivation] doesn't continue at the present rate, we might break the bank.'

Dr Garner says we are seeing increasing divergences. Scotland has rejected the idea of foundation hospitals, for example, and is placing much less emphasis on the private sector, which is, in any case, tiny compared to parts of southern England. But he, like others, is keen to see some real evaluation of which systems are working best and whether they could transfer successfully to the rest of the UK.

If devolution has done one thing, it has meant far more parliamentary debate about health than was possible at Westminster.

Scottish NHS Confederation director Hilary Robertson welcomes this, although she says health's high profile means it is always being intensely scrutinised.

She believes that devolution has given greater scope to, as the saying goes, develop Scottish solutions for Scottish problems. It has thrown up differences such as with the proposed consultant contract framework, which was accepted in Scotland but rejected in England. But in the next four years, she would like to see some changes. 'Health improvement should be topping everyone's agenda, not just in the health department.

'And we also want local health organisations, by which I mean NHS boards, to have the freedom to make more decisions within a national framework.'

She warns against further major structural upheaval - which has also been something of a mantra for Scottish secretary of the Institute of Healthcare Management Donald McNeill.

Asked to name the low points of the last four years, he unhesitatingly points to the 'unsustainable burden of paperwork' caused by meeting demands of the performance-assessment framework and other quality assurance groups.

He is equally quick to name his high points, however. 'do not get me wrong. I am not knocking the Parliament and I think It is done some good things, such as the new Mental Health Act, which I think will be good for Scotland.'

Speaking personally, rather than for the institute, however, Mr McNeill can't resist one dig. 'The Scottish Executive was quick enough to point the finger at health service managers in Tayside and Argyll and Clyde for going over budget by what was, in fact, a very small percentage, which caused a personal tragedy for some of these managers.

'But We have seen the costs for the Parliament building rise and rise.

What does that say about standards in public service?'

Single ticket to ride

At least six candidates are fighting the election on a single issue health or public services platform, hoping to emulate the success of Dr Richard Taylor in Kidderminster.

Four have joined to form a party, Local Health Concern.They include Margaret Hinds, a long-time health campaigner, who is standing in Glasgow Eastwood, and former lord provost Pat Lally, who is contesting Glasgow Cathcart.Both object to proposals in the Glasgow acute services review to concentrate acute services on fewer sites and build ambulatory care centres.

The other Local Health Concern candidates are in Fife.Brian Stewart is contesting the Dunfermline East seat and David Wishart is fighting for Dunfermline West.Both are standing in protest at plans which will see Fife's acute services concentrated in Kirkcaldy.

Back in the west of Scotland, retired GP Dr Jean Turner will fight Strathkelvin and Bearsden.She disagrees with plans to turn Stobhill Hospital into an ambulatory care centre.Danny McCafferty stood down as a member of Greater Glasgow Health Board to fight for the Clydebank and Milngavie seat in protest at plans to cut the number of accident and emergency departments in the area.

Manifesto commitments: who pledges what Labour

To set up an NHS Scottish Nursing Bank based in Clydebank to cover staff absence as an alternative to private agencies.Last week, health spokesman Malcolm Chisholm outlined a package of pledges to nurses including a 10 per cent pay deal over three years on top of Agenda for Change .

Labour would also follow through on pledges in February's white paper, Partnership for Care , which include abolishing trusts.

SNPTo offer nurses pay rises 11 per cent above UK rates to give Scotland a recruitment edge.Health spokeswoman Nicola Sturgeon said bed numbers should be determined according to meeting the needs of communities, not the balance sheets of investors, and investment targeted to 'frontline services rather than back-room bureaucracy'.

Scottish Conservatives To empower patients by giving them choice and information and decentralise power to hospitals and GPs 'so that they respond to the needs and priorities of their patients instead of centrally imposed targets and directives'.

GPs would have power to purchase all healthcare on behalf of patients and hospitals could go for foundation status and set their own pay and conditions.

Scottish Liberal Democrats To establish a 'unique long-term strategy, with an emphasis on health education, illness prevention, diet and exercise'.A spokesperson says: 'With free eye and dental checks, investment in our NHS and more nurses and doctors and action over bed blocking and waiting lists we are pledged to make the difference.Our influence over the past four years as part of the partnership government clearly reflects our real achievements and commitment to further reform.'

Others The Scottish Socialist Party, which had one seat in the last parliament, would phase out private healthcare, cancel private finance initiative projects and introduce a minimum£7.32 hourly rate for NHS staff.

The Greens, also with one MSP, would place more emphasis on preventative medicine and public health education, improve pay and conditions for health professionals, include complementary treatments 'of proven value' in the NHS and serve organic, locally produced food in hospitals.

The new Scottish People's Alliance, which has attracted two former Conservative MSPs, would abolish Scots MPs, cut income tax by 3p and give the NHS financial incentives to perform - by making hospitals do the work before they get paid for it.

Radical Wales: free prescriptions beckon Free prescriptions for everyone look set to return to Wales over the next four years.

The£6 charge - already lower than in England - will be abolished if Labour wins the National Assembly elections on 1 May.

This is a near certainty, although the party may have to make do with continuing to share power with the Liberal Democrats in a coalition.

First minister and Labour leader Rhodri Morgan said the abolition will cost£31m a year.But this includes an ambitious aim to reduce demand by 30 per cent.Making the announcement as the top issue on his party's list of 10 pledges, he admitted he could not say precisely when abolition will happen - there is insufficient spare cash in the Assembly budget for this year and next.