Research summary & report
11 Apr 2014

This report, published by the Nuffield Trust and the Health Foundation, assesses the performance of the NHS on the quality of patient care in all four UK countries since devolution.


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 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.

Wales’s lengthening waiting times should set alarm bells ringing amongst policy-makers when considering its possible impacts Andy McKeon, Senior Policy Fellow, Nuffield Trust

The four health systems of the UK: How do they compare? is authored by six leading health academics: Professor Gwyn Bevan, Marina Karanikolos, Jo Exley, Ellen Nolte, Sheelah Connolly and Professor Nicholas Mays. The team was led by Professor Nicholas Mays of the London School of Hygiene and Tropical Medicine.

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.

The report is accompanied two appendices, which include all the data and reference material. Further analysis of the history of the devolution settlement and the health policies of the four countries will be included in an analysis by Professor Gwyn Bevan, to be published later in 2014.

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