Devolved Healthcare in the UK's National Health Service: The Benefits and Drawbacks

David J. Kerr, CBE, MD, DSc


December 07, 2022

This transcript has been edited for clarity.

Hello. I'm David Kerr, professor of cancer medicine at University of Oxford. I must admit, I do enjoy working with WebMD and Medscape to provide these interesting videos — sometimes a very simple, factual description of a paper that's caught my attention and I think you'll find interesting, and sometimes rather more philosophical issues.

I do my best not to talk about my own work, but let's talk about a paper we published in The Lancet with former Prime Minister Gordon Brown, a fantastic politician, a statesman of global standing, and somebody who played an enormous role in 2008 in terms of the global recovery from the financial crisis at that stage. He is somebody who is well recognized and well thought of.

One of the things that he and I have been thinking about recently is how we deliver healthcare in the United Kingdom. You may or may not know that we have devolved governments now, which is a good thing. The more democracy we can deliver closer to the people and the more decision-making that we can put closer to the communities served by politicians, the better.

We had an interesting debate about healthcare. By accent and every other bit of me, my big potato head, I'm Scottish, a proud Scot. I do like the sense of the union. I like being part of the wider United Kingdom.

We have a national health service that we would argue is government's greatest gift to citizens. Enduringly, it is the most popular public service that we have, not surprisingly, because we deliver healthcare to one and all, free at the point of delivery. It's a fantastic thing, socialized, paid through taxation. Healthcare is one of the devolved issues that goes to Scotland.

We've been thinking, though, about the benefits to being part of a wider United Kingdom. That was the focus of our commentary. We think that there are issues like altering the workforce, training, and planning that may be better done on a wider scale against the devolved nations in England, Scotland, Wales, and Northern Ireland overall — the component countries that make up our great United Kingdom.

I'm thinking about big data, sharing data, and the speed and rapidity of research. I'm enormously proud of the fantastic contribution my colleagues in Oxford made, both to vaccinating the world — more than 2 billion doses of the Oxford-AstraZeneca COVID-19 vaccine have been delivered — and in the RECOVERY trial.

The trial was perhaps the most rapidly recruiting study globally to date, in which there was fantastic collaboration across all the devolved health services in the United Kingdom, and of course, spreading widely internationally so that we could answer questions as quickly as absolutely possible, finding treatments that helped COVID-19, and discarding treatments that were of no use whatsoever. This shows, again, the competitive advantage of countries working together — collaboration and collectivism rather than competition.

There are other issues within our socialized healthcare system around procurement on a wider scale and around delivery of highly specialized services. Clearly, the greater the number of the population of patients being treated in specialized centers, the better the outcomes are. There's quite a strong evidence base supporting that.

It's a debate that we've initiated, and it's one that I'd be really interested in your thoughts about. Whether your healthcare system is delivered locally, regionally, nationally, or even internationally, what do you think are the benefits of a collective and cooperative approach to healthcare? I'd be very interested in your thoughts.

As you may know [from previous commentaries] that I do a large amount of work with my friends and colleagues in sub-Saharan Africa. We're also doing work with friends and colleagues in Iraq and so on, where I think that cooperative models are essential. Even within a well-developed Western healthcare system, I think there are still real benefits to be had. I'd be very interested in your thoughts.

Have a look at our paper in The Lancet, think about it, and I'd be really interested to see what comments you might bring back.

As always, Medscapers, thanks for watching, listening, and reading. For the time being, over and out.

David J. Kerr, CBE, MD, DSc, is a professor of cancer medicine at the University of Oxford. He is recognized internationally for his work in the research and treatment of colorectal cancer and has founded three university spin-out companies: COBRA Therapeutics, Celleron Therapeutics, and Oxford Cancer Biomarkers. In 2002, he was appointed Commander of the British Empire by Queen Elizabeth II.

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