Political devolution within the United Kingdom provides an interesting opportunity for observational research on healthcare systems. Ten years in, differences in approach between the four nations are apparent. This divergence has taken the form of markets and performance management in England, cooperative medical professionalism in Scotland, localism and public health in Wales, and permissive managerialism in Northern Ireland.1 The key questions now are what difference, if any, does this divergence in approach make to those who receive NHS services, and what should be done about it?

These questions are tackled in the latest report from the Nuffield Trust.2 The trust and the authors of the report should be congratulated for trying to tackle such a complicated subject, particularly where vested political interests are concerned. However, the report focuses mostly on input and process rather than outcome measures, and the authors acknowledge that their analysis was hampered by a lack of comparable data, particularly on waiting times—a challenge that others including the NHS confederation have previously highlighted.3 They also suggest that the report is best regarded as an interim report and promise a further comparative work that uses a more regional approach. This is welcome, although promoting the north east of England as the comparator of choice for Scotland and Wales merits careful consideration, and it is unclear …