2007 may come to be seen as a watershed for the National Health Service, for reasons of politics that, for now, seem to have little relevance to those of us who work within it. The media suggests that there is a done‐deal amongst the political class which will bring a Scottish Prime‐Minister just at the moment that devolution may deliver a Scottish Executive committed to independence from Westminster. Some pundits seriously suggest that a constitutional crisis may ensue. Moreover, the constitutional status of Northern Ireland still seems as intractable and volatile as ever, while some within the Welsh Assembly advocate a devolved parliament for Wales.
Whatever one’s feelings about the political decisions ahead, there is no good reason to ignore the serious implications for the future of the NHS. At the very least, every aspect of the public sector and its funding is liable to be revisited in a new settlement between Scotland and England & Wales. However, for the first time in two generations, the possibility also exists that the NHS as we know it may have to be divided up between two or three new nations, with unavoidable consequences for policymaking and budgeting – not just at the moment of settlement but in the transformed political environments thereafter. Of course, there are few dissenting voices in public life regarding the desirability and relevance of a universal system of healthcare within the United Kingdom, but it is the very existence of the UK that may be at issue. This fact must have an impact on the NHS and its present practitioners: can anybody working in the NHS be sure, ten years from now, which country they will be living in, who that country’s policy‐makers are going to be and, therefore, who their employer is going to be?
On an international level, the recent furore about widely varying responses in different European health‐services to the so‐called ‘super‐bugs’, such as MRSA and Clostridium difficile, illustrates that such policies are bound to be based on local considerations – specific circumstances, available expertise, funding considerations, etc. It also shows that lessons can always be learned from the experiences of others. This point is not unrelated to that of the future of the NHS because it serves as a reminder that a shifting landscape of political policies is, at the end of the day, less relevant than something else: the free exchange of ideas across nations, amongst educated practitioners in open and informed debate, remains the bedrock of the advancement of healthcare and (is it too much to say?) the betterment of the human condition. You are, as always, invited to add your own contribution within the pages of this Journal.