I live in Scotland where since 2007 the NHS model has seen the removal of 'competition' within the NHS and direct Scottish Government action on poorly written PFI contracts, especially in the case of Edinburgh Royal Infirmary where it impacted on cross infection control. Further due to a change in how performance in NHS Scotland is now measured performance targets are increasingly linked to patient experience and not 'outputs'. The system is not perfect, no measurement system ever is, but at least NHS Scotland would be recognizable to Mr Beveridge's original 1942 idea of a NHS service, the White Paper of 1944 and the NHS Act (Scotland) of 1948.
Having worked in the NHS on both sides of the border all I can say of this latest plan for NHS England is it does not have patients needs and expectations at its centre. The chance to achieve that principal aim was lost when New Labour failed to back Sir Liam Donaldson's proposed reform of NHS management and delivery in the late 1990's. His aim was to take a proven UK created, world recognised and effective quality assurance management model and apply it to the NHS in England. The system was already in place in Sweden's equivalent of the NHS and proving highly effective at improving responsibility for delivery at all levels while holding all levels to account for their activities. In other words the Swedish had used the model to create a coherent and accountable public health care system with patient's needs and expectations at the centre.
The problem of this model for the NHS in general, at all levels of vested interests, is it requires all fiefdoms and empires to be broken up and the focus moved from the Secretary of State for Health's current political demand, for example, to that of patients' determined needs and expectations. This fundamentally changes the power cascade from top down to bottom up and reduces all vested interest control and inputs to the same value as the patient. The very apotheosis of Blairite and New Labour policy and politics. Systemic failures in Donaldson's proposed model for NHS England would go to the top where true accountability lay.
In Mid-Staffs the patient complaints would not have been dismissed in Donaldson's proposed model but would have acted as a driver to correct the issues causing the front line problems and put in place revised systems to prevent (as far is humanly possible) the same errors occuring at a future date. These problems and their effective solutions would then have been notified to all other NHS Trusts in England creating the prevention of possible problems occuring in the other trusts.
The bottom line was the implementation of Donaldson's model, in full, would have created the opportunity to save NHS England over a £1 billion in pay outs of out of court and court settlements for negligence and malpratice at 1996 figures.
Instead NHS England was given a fudge by New Labour which was simply smoke and mirrors and jobs for the boys and girls in the new 'NHS Quangos' while the vested interests carried on as before. More top end cost for little improvement in meeting patient's determined needs or expectations of NHS England. The Quango which was set up to patrol 'Clinical Governance' has been shown to have demonstrably failed in its core purpose of ensuring patient safety and best practice on numerous occasions. They gave Mid-Staffs a clean bill of health right in the middle of the unfolding disaster. NICE is notorious for shutting the stable door well after the horse has not only bolted but turned up in a Tesco burger.
Blair got his 'headlines' about NHS England improvement, patients' needs and expectations continued to be ignored while the plans for the marketisation (aka privatisation of NHS England) went on a pace starting with PFI and its effective selling off of hospital buildings and the land they were set on to the private sector. The cost of which is going to rise to all four NHS entities across the UK, with the downgrading of the UK's triple A rating, by a further estimated 33% over the period of the current contracts. In Scotland that will be an estimated £10 billion more lost to frontline patient care funding, on top of the current cut backs to Scotland's pocket money from Westminster which are already squeezing the NHS Scotland budget. The Red and Blue Tories at Westminster will then use the outsourcing of NHS activities in England to 'private companies' as an opportunity to reduce Barnet NHS consequentials to Wales, Scotland and Northern Ireland - even further.
A 'yes' to Scottish independence looks increasingly to be the only way to preserve NHS Scotland in its current form.