Devolutionary divergence will not derail notion of a national health service

Published: 16/05/2002, Volume II2, No. 5805 Page 19

Observers of Allister Stewart's career (see news focus, pages 16-17) will surely note its geographical spread as well as its eventfulness. As a young manager in Tayside, he was advised to get qualifications and go South. This he duly did, and his subsequent jobs took him to Wales and then back to Scotland.

It is interesting to wonder how different that journey might be for someone starting out now and whether devolution will have an effect on the mobility that has marked many managers' lives. There is little doubt that the health systems in England, Scotland and Wales are diverging (see features, pages 27-29). Scotland has emphatically dropped any idea of an internal market with a policy which emphasises partnership and a corporate approach to performance. Winners and losers remain clearly visible in the English landscape. The role envisaged for private providers in England is not reflected in Welsh and Scottish plans. England has the purchaser-provider split and primary care trusts with commissioning powers, while Scotland has local healthcare co-operatives.

So a manager moving round the service in the next few years will certainly meet with differences which did not exist in 1948. But to see these as the end of the NHS is to ignore the professional networks, common experiences and shared values which have sustained the notion of a national service through countless reorganisations and will probably be robust enough to survive many more.