Devolution and healthcare

Dr Grumble has always been suspicious of devolution. Why did our political masters in Westminster want devolved government for Scotland and Wales? Was it just to keep the Celts happy? Or was there a more sinister motive? You could be forgiven for assuming it was the former. But why did Westminster want to give up powers to the English regions when there was no clear demand or need for local assemblies? It didn't make sense to naive Dr Grumble at the time but it does now.

In its wisdom the government chose the North East for a referendum on a local assembly because they thought it the region most likely to approve the proposal. But the electorate in the North East, unblinded by any sense of nationalism, shared the Grumble suspicion and wisely voted against a regional assembly. Not, of course, that this was going to stop the government. Oh no.

For Scotland it was different. Many there had long wanted devolution or separation and many others must have felt stirred by feelings of nationhood and nationalism and general grouses about the English. The Welsh, though initially more sceptical, went the same way.

Dr Grumble never saw much for England in all of this. Hiving off chunks of government to Scotland and Wales would surely make the UK weaker on the world and European stage. That seemed bad for all. And there was the bizarre West Lothian issue which means that Scots can exert decisive influences on the government of England. Quite mad really. Not that the English seem to mind very much. The West Lothian question was asked by a Scot not an Englishman. And the English do not seem to be much bothered by the rule of a Scottish prime minister. Well they might be bothered by his rule but it is the nature of his rule and not his Scottishness that is the issue. And in that they may have a lot in common with the Scots.

This is how others describe the regionalisation sleight of hand:

Unelected regional assemblies were set up in the late 1990s as part of the government’s adherence to the agenda of the European Union to break up the power of national Parliaments. England was divided into nine regions, including London. The intention was for each of these unelected assemblies to become elected - and for England to be governed by nine regional Parliaments, each – like the London Assembly - being given powers currently held by Westminster. The plan always was to take some of the powers of national Parliaments up to the various European institutions and others down to a more local level, thus leaving national Parliaments with little to do, hastening calls for their demise. Very few are aware that the official title of the European Union is ‘The European Union of the Regions’ - not of the nations. Source.

What does the devolution of Scotland and Wales mean for England? One advantage for the hapless and disenfranchised English is that it does at least mean that the questionable policies emanating from Westminster are being challenged. Nationalism and distance from the malign influences of the policy wonks and self-interested profiteers of the south allow those in the devolved nations to question the Westminster's health management mantras and show that, yes, there is another way.

The potential importance of devolution in the development of healthcare policy was brought home to Dr Grumble when he read the response from the Centre for International Public Health Policy to the Scottish government's consultation on the European Commission's proposals on cross-border healthcare. Since we don't have an English government the consultation process for England was not focussed on England but UK-wide. Many found the proposal confusing and the response to the consultation was mostly shallow. But in Scotland things are different. There they question things.

If you have no idea what Dr Grumble is rambling on about have a look at what Julie McAnulty has to say on the topic of cross border care. She explains it all rather well. She doesn't actually mention Scotland and she even refers to Brits. These are issues that face the UK as a whole. But if you look at Allyson Pollock's critique (pdf) you will see that devolution may allow a Scottish response to this which will be denied to the English.

Would you believe that Dr Grumble was once a staunch euro-enthusiast? We all make mistakes. Dr Grumble failed to spot that the EU was heralding the post-democratic era. That has to be bad. Could it be why the public are now so very disillusioned with politicians? If you vote you want to vote for change not a new group of managers with the same policies as the other lot. That is the nub of the problem