A case for devolution of health care.

Devolution The BMJ held a one-day conference in Glasgow on 3 April. The participants, from England, Scotland, and Wales, discussed whether they would like the Health Service in each country to devolve and the probable effects of the Government's White Paper on devolution-Our Changing Democracy: Devolution to Scotland and Wales. By invitation three of the participants prepared working papers which were circulated beforehand. These are printed below, together with an edited version of the discussion. The sessions were chaired by the editor of the BMJ, Dr Stephen Lock, and an assistant editor, Dr Gordon Macpherson. The new Scottish dimension to British politics makes devolution' almost certain, and indeed there is a likelihood now of a strong legislative assembly with economic power. The changes in Wales, though similar, would be less radical. The medical profession in Scotland, given the chance, would probably vote against devolution, but as medicine is being taken along by the strong devolutionary tide, a Canute-like stance against it is not appropriate. Thus rather than detain ourselves over the merits of devolution, it would be more important for the health care workers in Scotland to make contingency plans for the coming of the assembly. Nevertheless, it is worth going over the case for devolution briefly, and many of us prefer to be cheerful about its effects. The usual arguments for devolution are not entirely applicable to Scottish medicine (unlike, say, the Scottish economy or land ownership) since we have a degree of devolution already. We have our own health care administration at the Scottish Home and Health Department in Edinburgh and we have our own colleges of physicians and surgeons, in which we take a touchy pride. The survival of our traditions and the persistence of a good health service in Scotland is partly due to devolution to these fine institutions. None of the critics of devolution, I think, would wish to do away with these bodies. Thus when we talk of devolution in health care it is of the devolution of political control of medicine to the Scottish Parliament, and the discussion, on both sides, must inevitably draw from personal convictions about the optimal size of governmental units in the UK. The arguments for political devolution in medicine are in miniature those for devolution in general. A Scottish assembly would encourage the separate character of Scottish medicine, it would study and respond to the particular needs of …