THE flu epidemic is generating a debate over the Scottish health service even shriller than usual. To read some Unionist pundits, you would think the whole system was close to collapse: all the fault of the SNP government, of course, and probably an inevitable result of devolution.

Given this cacophony, it’s hard to know where to start getting to grips with the real problems. But I have been reading a report from the Nuffield Trust, Learning From Scotland’s NHS, by Mark Dayan and Nigel Edward (available at www.nuffieldtrust.org.uk). Tories, Labour and LibDems might think this a ribald title, but they should take a closer look. While the trust is an independent research institute based in London, it is free from English prejudice. In fact it is in the course of producing a series of reports on each of the four health services in the UK, without any prior assumption that one or other of them is superior – and certainly not that the biggest, in England, somehow sets the gold standard for the rest. The trust sees for itself the problems of remaining objective. It notes that Scotland has a “polarised political culture, with the SNP Government seeking majority support for independence and a largely hostile press looking to attack their record on the NHS”. Needless to say, the report has been pretty much ignored in the Britnat mainstream media – though not by The National – since it came out towards the end of last year.

The conclusions are wide-ranging, and as much qualitative as quantitative. The most important seem to me to be these: “Scotland has a unique system of improving the quality of health care. It focuses on engaging the altruistic professional motivations of frontline staff to do better, and building their skills to improve. Success is defined based on specific measurements of safety and effectiveness that make sense to clinicians …

“Scotland’s smaller size as a country supports a more personalised, less formal approach than in England. The Scottish NHS has also benefited from a continuous focus on quality improvement over many years. It uses a consistent, coherent method where better ways of working are tested on a small scale, quickly changed, and then rolled out. Unlike in the rest of the UK, this is overseen by a single organisation that both monitors the quality of care and also helps staff to improve it.”

Reading this sound and sensible stuff reinforces my own view, eccentric though it may appear to more progressive readers, that Scotland is actually quite a normal western country, with a social and economic structure common to the type. It has its share of faults and defects, to be sure, but basically offers its people a contented existence amid freedom for all. They may not always achieve contentment, partly through misfortune or partly by their own fault, which is why we have set up health and welfare systems to carry them through.

It is a pity this commonsensical position is subverted in particular by our armchair socialists, many living themselves in some degree of bourgeois opulence, but constantly harping on about how everything in this country conspires towards the oppression of the Scottish working class. At least if they will read Learning From Scotland’s NHS they may find out that in certain respects things are actually worse for the English working class.

Still, in this season when we are urged to see ourselves as others see us, I want to widen my terms of reference. It seems to me anyway a mistake to assume England is always the relevant comparator for Scotland, especially when we find, thanks to the Nuffield Trust, that what we think of as Scottish values do find some reflection in our most vital public service. And as we know, we have affinities with other nations too.

In the course of my life I have been enrolled in two health services apart from the NHS. For my four years altogether as a resident alien in the US, it was obligatory for me to take out private health insurance, since the immigration authorities do not allow any foreign additions to the uninsured masses.

I chose a policy covering me for $2 million worth of medical treatment. I reckoned if I needed any more than this I would probably be dead. Besides, when I worked it out, the premiums did not appear higher than that part of my tax bill at home which previously had gone to the NHS, about a third of the total.

But by the time I moved to Los Angeles, I found I could have spared myself the expense. As an employee of the University of California (which was now my official status) I could benefit from its health scheme, with membership at a favourable rate.

I never took advantage of my cheap treatment, not even when the local smog turned so bad as to irritate my lungs and make my eyes water. But, for the purposes of this column, I have had a look at what an average experience would have been in my nearest hospital, the Huntington Memorial at Pasadena (in California the information is published online for all 187 hospitals in the state).

On arrival I would have spent 24 minutes in the emergency room. But I would not have waited more than four hours before being sent home, and meanwhile not more than 90 minutes for anaesthesia if I had a broken bone, or not more than 169 minutes if I needed to be put to bed – in my own room, of course. Nobody pretends all this comes cheap. The cost of it in the case of setting a broken bone, including a single night in the hospital, would have been $793: easy to see why medical insurance is obligatory for resident aliens.

The second health service in which I have been enrolled was in Germany for the periods of my researches at the Max Planck Institute in Frankfurt, a federal foundation, and at the University of Leipzig, in the state of Saxony. The service has reciprocal rights with the NHS (till we leave the EU at least) so that any tourist from the UK who falls ill can just go to a local doctor. But all longer-term foreign residents need to sign up with the German system. It is based on compulsory private insurance, half paid by the employee and half by the employer. This seems to me to have the huge advantage of making the system financially autonomous, and not subject to the vagaries of official public expenditure with its funding feasts or famines. There are no cuts to the health budget in Germany.

One result is that there are in general no waiting times either. On the whole, if diagnosed with cancer at the beginning of the week, you will be in hospital by the end. It helps that there are about 1000 public hospitals in Germany. There are almost as many private hospitals, often specialist, but not necessarily there just for a social elite: a good number are charities, usually religious, so not seeking to make a profit out of their patients. The diversity and especially the number of German hospitals seems to be the key to the rapid admission process. It marks a strong contrast with the state of affairs in Scotland, where we have taken to keeping people out of hospitals rather than taking them in. This is on the face of it a sensible policy: better, surely, for those who can to go home and be looked after by family or friends in reassuring surroundings. At any rate it is a cheaper policy.

Germany, on the other hand, relies on a system with much greater capacity and so presumably with a good deal of under-utilisation as well – which would itself be matter for complaint if it were over here.

It is only possible in a country wealthier than ours, enjoying a steady growth rate and so able to afford the luxury of a sophisticated health service giving priority to the requirements of its patients rather than of its accountants. Given that our government is not even interested in the economic growth which is the absolute precondition of all this, in Scotland we will probably need to stick with the baby boxes.