Britain has 'four different NHS systems'

Devolution has inspired four different National Health Service systems each with their own priorities, a health boss said on Wednesday.

Gill Morgan of the NHS Confederation said patients are receiving different services depending on whether they live in England, Scotland, Northern Ireland or Wales.

Each system had certain advantages, and the differences would become greater over the years, she said.

The NHS was based on the guiding principle of a universal system when it was set up after World War Two in 1948.

Morgan, whose organisation represents NHS trusts and health boards, told the BBC Web site: "We basically have four different systems albeit with the same set of values."

She described it as a split in philosophy.

The model in England had become one of "contestability and choice" where outside organisations have been brought in and patients can shop around.

In Scotland, the system was more "collectivist", where health managers had opted to provide free personal care rejecting the means-tested system in place elsewhere.

"They have been slower to improve waiting than England, but much less tension exists between doctors and managers," she said.

Northern Ireland had adopted a more integrated system between health and social care, while Wales had made a point of providing free prescriptions.

"All we can say is that patients are experiencing different systems -- each one has its advantages and we will have to wait to see what happens," she told the BBC.

Patient Concern said the differences were "breeding envy".

"Patients are increasingly looking across national borders and wondering why they are not getting the care others are getting," Joyce Robins told the Web site.