The general election has once again raised the question of just how ‘united’ is the kingdom we live in.

In the NHS, there have always been different policy approaches in the four UK countries, giving them scope to learn from each other.

The review of NHS education and training in Wales, published shortly before the election, highlights a country with similar workforce problems to the other three UK countries.

Poor links between planning and education, a narrow uni-professional focus and fragmented planning were all identified in the review. Out of a total healthcare education and training budget of £350 million for 2014/15, £268 million was allocated to doctors and dentists, with just £82 million for all non-medics, including nurses. Nurse recruitment was reported to be a ‘major headache’.

The review suggests setting up a single body to cover planning, commissioning of education and training. It also suggests the current planning and commissioning model in NHS England is not as relevant to Wales as that used by NHS Scotland.

Compared with reforms in the other UK countries, the health system in Scotland has been relatively stable over the past 15 years. It emphasises partnership working and has long operated without an internal market.

Planning and commissioning are more likely to succeed where the model that is used aligns with the broader vision and strategy for health services delivery.

While the Scottish model may ‘work’ for NHS Scotland, it cannot be tranferred to Wales successfully unless broader system characteristics are also considered.

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