Feature NHS Organisation

How different are NHS systems across the UK since devolution?

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f3066 (Published 14 May 2013) Cite this as: BMJ 2013;346:f3066
  1. Nigel Hawkes, freelance journalist
  1. 1London, UK
  1. Nigel.hawkes1{at}btinternet.com

As NHS systems have moved in different directions, Nigel Hawkes examines the challenges of determining whether one country is doing better than the rest

Almost 14 years after devolution sent the component parts of the United Kingdom off in different directions, it ought to be possible to work out whether the quasi-market of the English NHS has worked any better than the more statist approach retained (or reintroduced) in Scotland, Wales, and Northern Ireland.

There are certainly strong views across the different borders. Seen from a London perspective, the policies of the devolved administrations seem timid and complacent. But the view from Edinburgh, Cardiff, and Belfast is that the English NHS is chasing a chimera of market driven improvement that owes more to doctrine than to evidence.

Neither of these caricatures is wholly true, and real differences in approach between all four systems do exist. So does the evidence emerging indicate whether any one approach is producing better results than another?

The National Audit Office (NAO) and the Nuffield Trust have carried out comparisons recently and, although data kept by each system are not directly comparable in many areas, the reports suggest substantial variations in areas that are important to patients, such as staff to patient ratios, waiting times for inpatient treatment, and patient care.

Scotland has the most staff, the worst health, and the lowest hospital productivity, according to Nuffield’s report,1 while England occupies the other extreme on all these measures. Scotland narrowly outperforms England in the Quality and Outcomes Framework for primary care, as does Northern Ireland. Scotland’s waiting times for inpatient treatment are also slightly better than England’s, according to the NAO, with Scotland claiming that 92% of patients are treated within 18 weeks against 90.5% in England.2 Both reports found that England spends …

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