Scotland reduces post-code lottery for hip replacement surgery

Using NHS Scotland data, researchers at the Centre for Primary Care and Public Health at Queen Mary University of London with colleagues from the University of Edinburgh and Lothian University Hospitals NHS Trust, show that access to hip replacement increased and geographical inequalities improved across all geographical health boards since 2003 when waiting time initiatives in Scotland were introduced. A key factor was the Scottish government's decision to buy the privately owned Golden Jubilee National Hospital in Clydebank and run it as a major NHS centre for orthopaedics and a national resource dedicated to reducing waiting times in key elective specialties.

The authors suggest further research is required to assess how these reductions in inequality by geography relate to differing levels of need for treatment.

One of the researchers, Professor Allyson Pollock, said: "Scotland has managed to improve and increase access to treatment for all patients by expanding capacity within the NHS, unlike England which has placed increasing reliance on poor value contracts with the private sector to deliver elective treatments." She added: "While England has decided to go down the private route there is growing concern south of the border about rationing and denial of surgery".

The researchers point to the difficulty of doing a similar study for England to examine the effect of using the private sector in waiting time initiatives due to the numerous organisational changes that have abolished health authority boundaries and poor quality data returns from the private sector.