THE NHS in Scotland came into being on July 5, 1948, the same day as in England. I was rather shocked to realise that I had actually graduated in the first half of its life, in 1982!

At that time, most patients were treated on Nightingale Wards (as seen in the old Doctor films) in Victorian-era hospitals and waiting times for low priority operations were measured in years.

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Over my time in the NHS, I have seen new hospitals built, the introduction of the first CT and MRI scanners, multiple new drugs for cancer and life-threatening conditions and we are now entering the age of tailor-made gene therapies.

So, contrary to popular assumption, the increased demand faced by the NHS is not just about serving an older population.

On Saturday, I was honoured to speak at the huge rally in London which was not just to celebrate the 70th birthday of the NHS but also to fight against the privatisation undermining it in England. Since devolution, the health services north and south of the Border have diverged significantly in structure, financing and the approach to improving standards of care and patient safety. These key differences were highlighted last year in a report by the health-focused think-tank, the Nuffield Trust, called “Learning from Scotland’s NHS”.

Over the last 20 years, Scotland has focused on the integration of hospital and community care, and is now tackling the integration of health and social care. Meanwhile a market approach has been foisted on the English NHS.

While it was Labour who introduced private healthcare companies to the NHS, and saddled all four health services with financially-crippling Private Finance Initiatives (PFI), it was the Coalition Government’s Health and Social Care Act that forced healthcare contracts to be put out to tender between the NHS and private companies.

This resulted in many NHS services in England, at hospital, community and primary care level, being taken over by private providers such as Virgin Care, Circle or Capita.

The tendering and legal processes of this competitive healthcare market are estimated to waste £5 to £10 billion each year and led NHS England into debts of £2.45bn in just three years.

In addition, Surrey Commissioning Groups paid huge settlement costs after Virgin sued the NHS – for not getting a franchise renewed!

This debt is leading to cuts and rationing of common treatments, such as joint replacements and cataract surgery, along with extensive closures of beds, A&E departments and even hospitals.

England already has one of the lowest ratios of hospital beds in Europe, with just 2.4/1000 compared to Scotland with 4.2/1000. This is partly why NHS Scotland has been the best performing UK health service for the 4-hour A&E target since March 2015.

In Scotland we believe in investing in people’s health and spend over £150 more per head than south of the Border. This helps provide free prescriptions to ensure people take their medication; joint replacements and cataract surgery so older people can remain active and free personal care so they can stay in their own homes rather than ending up in care homes or stuck in hospital.

An even deeper problem for NHS England comes from the fragmentation which results from having financial competition as its main philosophy.

Financial incentives are used to set performance targets at the time of commissioning services, while a threatening regulatory approach is taken by the Care Quality Commission when judging it.

This financial competition prevents co-operation between units, makes navigating patient pathways a nightmare and was found to lie at the heart of the Mid Staffordshire hospital disaster. Staff concerns were ignored as the key aim of managers was not patient safety but becoming a Foundation Trust hospital.

In contrast, since 2000, Scotland has encouraged co-operative working by teams across the whole system to improve clinical quality and safety. We developed extensive quality improvement standards to drive up performance (I had the satisfaction of developing the breast cancer standards) while quality audit in England largely fell by the wayside. In 2005 Scotland introduced the first ever national patient safety program which took many lessons from the airline industry and was designed with frontline staff from the start.

It is used right across Scotland and has significantly decreased avoidable hospital deaths.

As the NHS turns 70 years old, all four UK national health services face the same challenges of increasing demand, workforce shortages and tight finances. Despite all the newspaper headlines, most patients have a good experience in each of the services because treatment is delivered by dedicated and caring staff.

However, in Scotland, we are lucky to still have a unified public NHS which remains close to the original principle of the founding generation 70 years ago.

Dr Philippa Whitford is a breast surgeon and MP for central Ayrshire