National Youth Agency: Comment - Who makes the decision?

January heralded a debate about the differing approaches of the devolved administrations to the delivery of the health service. Basically, the four countries in the UK provide a different offer to the public. The government was clear: the variation is down to the needs of the local populations. People in Wales are more likely to have chronic illnesses so the priority there has to be prescription charges. In other places waiting lists are more important. I listened to this unfold and it seemed to me it was the classic rationale put forward by those responsible for making decisions about scarce resources. I don't envy those who make these decisions. It is never easy and we have all, to some extent, had experience of doing this. The trouble with these decisions is that there are always unintended consequences and lost opportunities. If you have a chronic illness and live in Telford you could also do with not paying for prescriptions. It is not as simple as the exposed rationale would suggest. The public purse is becoming tighter and this will lead to increased scrutiny on any spend where there is no clear benefit - the question is "who" and "how" determines benefit.