NHS Norwegian style

I met a delegation of Norwegian trade unionists today, including Asbjorn Wahl author of 'The Rise and Fall of the Welfare State'. We have welcomed a number of these visits in recent years because they are interested in our NHS structures and in particular how we keep marketisation at bay. In Scotland we often look to Norway and Scandinavia more generally for inspiration, so it makes a change to able to show them a model they would like to replicate in Norway.

Their hospitals are administered on the trust model and I was able to offer some advice on how we challenged the inefficiencies inherent in this model. The huge administrative waste     in running contracts, marketing and other pseudo commercial functions divert scarce resources from healthcare in Norway as they did in Scotland before we abolished them.

Where I believe we can learn from them, is their integration of social and primary care at the local authority level. Although they pointed out that this still creates problems between acute and primary care. Of course they have local councils representing real local communities rather than our large scale regional authorities. Visitors from Norway are always astonished when you tell them how big our councils are.

While there is a natural tendency to talk up the strengths of our NHS model it is important that we are honest about the weaknesses. Our local NHS structures have a huge democratic deficit and only limited community engagement. They noted the difference between the BMA's view of direct elections and ours! Senior doctors don't do democracy in Scotland, or I suspect elsewhere.

We also have to recognise that we haven't cracked health inequality. I argued that this is less an issue for the NHS and more for wider social policy. They also recognise the groundbreaking work of the Spirit Level in understanding that more equal societies do better on every count. They start from a better place than us in addressing this issue.

As always it is a pleasure to meet colleagues from other countries and from Scandinavia in particular. While we have more to learn from them, it makes a welcome change to be able to offer some advice on how to address the weaknesses in their system.