Significant improvements have been noted in the health services of four countries of the UK since devolution despite major differences in policy, a major report has found.
Tougher sanctions and targets in Scotland have led to improvements, however austerity has led to rising waiting times in Wales.
Although policy has diverged in each country, devolution has led to a narrowing in the performance gap between England and the rest of the UK.
Significant improvements have been noted in the health services of four countries of the UK since devolution despite major differences in policy, a major report has found.
Tougher sanctions and targets in Scotland have led to improvements, however austerity has led to rising waiting times in Wales.
Although policy has diverged in each country, devolution has led to a narrowing in the performance gap between England and the rest of the UK.
England has implemented a greater emphasis on patient choice and the use of private sector providers, however competition has been rejected by Northern Ireland, Scotland and Wales.
On spending on health care, the study finds:
– All countries substantially increased investment in their health systems doubling in cash terms (not adjusted for inflation) the amount spent on health care across the UK between 2000/01 and 2012/13 and investing in more staff.
– But there have been divergent spending decisions, with Scotland spending almost £900 million from the money notionally available for health on other services or on making existing services free of charge including free personal care for older people, and Wales spending around £450 million on other services.
– Spending across the board has slowed in response to austerity. Over the three years from 2010/11 to 2012/13, the annual rates of change were: growth in Northern Ireland of two per cent; England and Scotland of one per cent; and a reduction in Wales of one per cent.
Today’s report is based on in-depth analysis of around 20 indicators, comparing the performance of the four UK health systems over the past two decades, from the 1990s up to the latest point at which comparable data are available (in some cases 2012/13).
Andy McKeon, senior policy fellow at the Nuffield Trust, said: "What is interesting is that, despite hotly contested policy differences in structure, targets, competition, patient choice and the use of non-NHS providers, no one country is emerging as a consistent front-runner on health system performance.
“Only time will tell if the four countries’ progress made to date will be sustained as austerity starts to bite. But Wales’s lengthening waiting times should set alarm bells ringing amongst policy makers when considering its possible impacts.”
Dr Mark Porter, chair of BMA Council, said: "This report highlights a clear link between investment in staff and services, and improvements in patient care. Rather than wasting billions on unwanted changes to the NHS in England, this money would have been better spent improving frontline services, delivering more joined-up care and addressing variation in care where it exists.
"My real fear is that opening up the NHS to market forces and the fragmentation of services resulting from NHS changes will leave patient care and frontline services irreversibly damaged."
