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4 - The devolved nations

Published online by Cambridge University Press:  03 April 2024

Mark Exworthy
Affiliation:
University of Birmingham
Russell Mannion
Affiliation:
University of Birmingham
Martin Powell
Affiliation:
University of Birmingham
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Summary

When … established 70 years ago, inspired by Aneurin Bevan and the model of the Tredegar Medical Aid Society, the NHS was visionary, bold and radical. … But we no longer live in the world the NHS was originally designed for. … We acknowledge the level of challenge to meet the aspirations of this plan, but … this can be met if we can rediscover the confidence and bold ambition that made Wales the birthplace of the greatest National Health Service in the world. (Welsh Government, 2021)

The government decides the policy for the NHS, it decides the funding for the NHS, we fund the NHS to a higher level proportionately than other governments across the UK and we’ll continue to do that. We’ll continue to have the difficult discussions with those who run the NHS … about how we ensure the sustainability of the service. But the founding principles on which that service is based are not up for discussion by government and will not change. (Scottish First Minister, 2022)

The World Health Organization defines health as ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’. That is the health outcome I want to deliver for our people. … We are facing a time of change for our health system but it is change that must happen. This document sets out a direction of travel that I hope all of our society can embrace and support in the challenging but exciting time ahead. (Northern Ireland Executive, 2016)

Introduction

The first of these revealing statements, by the Welsh Labour Secretary for Health and Social Care, gives a partial account of the origins of the National Health Service (NHS). The second, by the then Scottish National Party (SNP) first minister, emphasises her government’s commitment to NHS ‘founding principles’. The third ignores NHS history, with the Sinn Féin minister citing a post-war World Health Organization aspiration. None mentions the UK or NHS England. We are thus alerted to healthcare’s highly politicised nature, the relevance of its history, the significance of devolution, and that its treatment in many social policy and historical texts notwithstanding, the ‘NHS’ is not monolithic.

Type
Chapter
Information
The NHS at 75
The State of UK Health Policy
, pp. 71 - 89
Publisher: Bristol University Press
Print publication year: 2023

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