At the British Medical Association’s annual conference this month, chair Hamish Meldrum put in a plea for England to emulate Scotland’s anti-market approach



He advocated ditching the “shoddy supermarket war” and use of the private sector and foster co-operation and collaboration.

The “English disease” had not, he claimed, led to improvements in quality or efficiency.

Aside from the fact that most of the BMA’s members make a reasonable living from selling their services privately - including most GPs - it is useful to look at the facts on NHS performance north and south of the border before jumping to conclusions about which direction to take.

One fact is prominent: on average, from 2000-08, Scottish NHS spending per capita has been around 18 per cent higher than in England. Last year it was over 20 per cent higher (see first chart), at nearly£2,000 per head.

As Scottish spending has been significantly higher than in England for many decades it might be expected that the system north of the border has a head start. Indeed, it has more beds, more consultants, more GPs, more nurses - even more administrative and clerical staff - per head of population than England.

Per thousand population, there are around 20 per cent more consultant staff in Scotland, 28 per cent more qualified nurses, 40 per cent more administrative/support staff, 53 per cent more GPs and 635 more beds. But do more inputs imply more outputs? Well, to an extent. There are more operations: 7 per cent more per 1,000 population than in England (see second chart). But overall, 20 per cent extra spending per head does not buy 20 per cent more activity.

With no sophisticated measures of productivity available, crude ratios of outputs to inputs suggest the Scottish NHS does not use its resources nearly as productively as in England. Operations per consultant are around 12 per cent less than in England; admissions to hospital 18 per cent less and inpatient and day case episodes per bed around 40 per cent less (third chart).

There are of course reasons why outputs could be lower than expected in Scotland. Need may be higher and achieving equity of access may be more expensive given its geography. And the statistics can always be disputed of course. But the size of the gap is significant.

The English NHS, it would appear, is more productive than the Scottish system. Why this is so probably has its origins in some of the reforms that Hamish Meldrum has objected to.