Intended for healthcare professionals


Devolution and health: data and democracy

BMJ 2014; 348 doi: (Published 12 May 2014) Cite this as: BMJ 2014;348:g3096
  1. Scott L Greer, associate professor, health management and policy
  1. 1University of Michigan School of Public Health, Ann Arbor, MI 48109-2029 USA
  1. slgreer{at}

Political decisions are reducing access to comparable data, yet pressure from voters pushes politicians to improve health systems

Devolution in the United Kingdom is about as good a natural policy experiment as we could imagine. With devolution, the health systems of Northern Ireland, Scotland, and Wales became the responsibility of new democratic governments. Devolved politicians accountable to devolved voters gained responsibility for providing healthcare and the opportunity to enact reforms, creating four divergent health systems.

The Nuffield Trust and the Health Foundation are among the few organisations that have tried to learn from this experiment. Their fourth report on devolution and health is ingenious and thorough, required reading for anyone wanting to understand health policies in the UK.1

While health policies diverged, the report apparently shows that no health system is clearly superior. Health and healthcare improved everywhere. With rising expenditure the rightly named “crude productivity” fell, but quality probably improved.

Judging by this report it is not possible to ascertain from existing data the best way to …

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