Reorganizing the British National Health Service.

I propose to discuss certain developments in health care arrangements which are planned in the United Kingdom. I will discuss these in terms of Scotland which has a separate health service and a separate health department for which the Secretary of State for Scotland with one of his junior Ministers is responsible to Parliament in Westminster. When the National Health Service was established, Scotland had its own National Health Service Act, and in preparation for the reorganization of our Scottish National Health Service in April, 1974, Parliament has just passed another National Health Service Act for Scotland. The specifications and arrangements of the National Health Service in Scotland and in England and Wales are very similar. Similar changes are proposed in our programs of reorganization, although in Scotland we are slightly ahead in terms of our timetable. I will try to present aspects of our experience which may be of interest to you, but let me state at the outset that there are no blueprints for health services. Each country's health services are a product of its culture and political traditions, and there is no place for chauvanism in discussing international differences in health services. At the same time, there are broad similarities between us; our problems have the same common base in developing medical science and technology on the one hand and public expectations on the other. In fact I suspect that the essential problems of health service development facing us today in Western countries are becoming steadily more similar, although the structure and administrative arrangement may be very different. I believe too that we each may see ourselves more clearly in the mirror of a foreign experience. It is with this hope in mind that I will tell you something about our plans in Scotland. We look back now almost a generation to 1948 when our National Health Service was introduced. The National Health Service was brought into existence in a mood of wartime and postwar idealism. It was a central part of a much larger program of change in social services framed to achieve a better society and a more equal and purposeful distribution of resources. The National Health Service took over the preexisting health services and made them available to all as a right of citizenship and without payment. Responsibility was given to Health Ministers and central government departments to promote health, prevent disease, and to provide