I’ve just found myself shouting at the television as I happened to have the misfortune to see part of a programme on BBC1 called Dom’s on the Case that looks at healthcare provision in the UK. There were 2 main parts to the programme that I found particularly twisted.

First of all there’s a village in Cheshire – Audlem – that has voted to become part of Wales, not because they want a decent rugby team or anything like that, but because – get ready for it – drug prescriptions are free in Wales, and prescriptions are £7.10 in England. The programme did not of course mention the flip side of this, that waiting lists have decreased more slowly in Wales than they have in England (as far as I can tell).

Secondly there was a man very seriously ill with kidney cancer living in Oxfordshire where the local health authority had refused to pay for his drugs, while if he lived down the road in Buckinghamshire the drugs would have been paid for. Cue plenty of film of his family stating how he should have received the drugs as he had paid taxes all his life, etc., etc.

So what’s up here? Essentially there cannot be a universal standard of healthcare provision across the whole of the UK while decisions on drugs (and indeed other things) are taken locally. Either the government has to set the standard for the whole of the UK in one go, and pay for this accordingly, or, alternatively, differences between different regions should be allowed – but financial and political responsibility should be connected. So if Oxfordshire wants to have a low tax, few drugs on prescription system, and Buckinghamshire wants to tax its citizens more so all the drugs can be provided then that’s OK.

The problem we have at the moment is that the system is neither one nor the other: decisions are not national, they are partially local, but these decisions are not accountable either. Hence the term postcode lottery so loved by British journalists. Why, oh why, rather than whingeing does no-one ever point out that this is a systemic problem? When politicians say they want local control of the NHS that means there will be differences between regions – are we OK with that or not?