The four health systems of the United Kingdom: how do they compare‪?‬

Since political devolution in 1999, there has been increasing policy divergence between the health systems of the four countries of the United Kingdom (UK). This raises questions as to whether health system performance is improving and at the same or different rates across the UK as a result. This report attempts to update earlier comparisons of the publicly financed health systems of England, Scotland, Wales and Northern Ireland in terms of funding, inputs and performance before and since devolution. It also includes comparisons with the North East of England, which has been chosen as a better comparator with the three devolved nations than England as a whole (although there is no perfect comparator). 

The research is the only longitudinal analysis of its kind, building on a previous report published by the Nuffield Trust in 2010 and revised in 2011. That report presented three snapshots before and after devolution, with the most recent data being for 2006/07. This latest report gives trends over time for a wider range of performance indicators from the late 1990s to 2011/12, or 2012/13 where data were available. It inevitably looks back and therefore cannot take account of very recent policy changes; for example, efforts to improve stroke care in Wales, and increases in nurse staffing in England following the publication of the Francis Inquiry Report. Furthermore, as there is always a lag between changes in policy and their impact on services, there is little evidence of the effects of the reductions in the rates of growth of public spending on health care. 

The research was commissioned by the Nuffield Trust and the Health Foundation as part of both organisations’ role in providing independent analysis on the quality and productivity of UK health services. All these materials are available at www.nuffieldtrust.org.uk/compare-uk-health and www.health.org.uk/compareUKhealth.