241960 Scotland's "mutual" National Health Service and the role of direct elections

Tuesday, November 1, 2011: 2:30 PM

Prof Peter D. Donnelly, MD MPH FRCP FFPH , Professor of Public Health Medicine, University of St Andrews, St Andrews, Fife, Scotland, United Kingdom
Scott Greer, PhD , School of Public Health, Dept. of Health Management and Policy, University of Michigan, Ann Arbor, MI
Ellen Stewart, MA (Hons) MSc , Medical and Biological Sciences Building, University of St Andrews, Fife , Scotland, United Kingdom
Iain Wilson , Medical and Biological Sciences Building, University of St Andrews, St Andrews, Fife, United Kingdom
Scotland has since 1948 had a national health service centrally funded from taxation and free at the point of use. For its first 5 decades the Scottish NHS was similar in its managerial arrangements to that in its neighbor England. However in the decade that followed the restoration of the Scottish Parliament in 1999, the two health services have progressively followed separate paths. Thus whilst in England managed competition and family practitioner commissioning is set to become the norm, Scotland sticks to a more traditional model with 14 geographically defined health boards responsible for both planning and delivering health care to their resident populations. Central to this difference is the Scottish NHS concept of mutuality; a term which encompasses solidarity, collective ownership and responsibility for the NHS as a valued national institution. This talk will explore this concept in relation to the introduction, for the first time, of direct elections to 2 of Scotland's 14 Health boards. In particular it will explore whether this process may further enhance accountability and increase local involvement or whether the factionalism that may result could threaten the very concept of a mutual NHS. The presenter is one of a team of 4 involved in evaluating the impact of direct elections and the methodological challenges involved in addressing these questions will be discussed.

Learning Areas:
Provision of health care to the public
Public health administration or related administration
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Describe the concept of mutuality and its centrality to Scotland's free at the point of usage National Health Service Explain the introduction of direct elections to membership of two of Scotland's 14 geographically defined Health Boards Discuss the implications of these elections for the operational functioning of the concept of mutuality in particular in relation to accountability, participation, representativeness and possible factionalisation

Keywords: Health Service, Accountability

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am Professor of Public Health at the University of St Andrews and one of a group of 4 individuals who are evaluating the Scottish Direct Health Board elections
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.