Health systems in the COVID-19 crises: Comparative patterns of NHS satisfaction and preferences for public health action in Scotland and England

Abstract

It is often claimed Scotland is more social democratic in outlook compared to England, if this is the case then we might expect to find differences in public attitudes towards health and social justice, reflecting the growing health policy divergence between the two nations. Comparative attitudes towards healthcare in Scotland and England are worthy of close scrutiny here, given the different reform trajectories, with the running of the Scottish NHS based on professionalism and the English NHS structure built on market-based principles. The Scottish Government also implemented stricter lockdown restrictions compared to the UK Government in England. However, the extent to which the policy responses to the pandemic reflect different attitudes towards collective public health action in the two countries remains under-researched. In this article, public attitudes towards health in Scotland are compared with those in England. The comparative analysis relies primarily on survey data from the International Social Survey Programme (ISSP) module on health and healthcare. This survey was fielded in Scotland and England in the autumn of 2021, during the COVID-19 pandemic. Overall, Scotland is more solidaristic or ‘social democratic’ than England on key issues relating to public health action and social justice. The findings reveal some commonalities between the nations, confidence in the NHS during the pandemic, and a willingness to improve the health service via higher taxes for example, but also important differences in attitudes and preferences for state action exist that help set the scene for greater policy divergence in the UK.