The health services of England, Scotland, Wales and Northern Ireland are all funded by the UK taxpayer, but since political devolution in 1999 they have developed different policies and systems of governance. Here we examine the impact of these changes by studying key performance indicators across the four UK countries.

Our analysis forms a central part of our work programme on UK and international comparisons. By looking at established best practice, we aim to bring the benefits of international experience to the attention of UK policy-makers and health leaders.

In April 2014 we published a major new report in partnership with the Health Foundation, assessing the performance of the NHS on the quality of patient care in all four UK countries. The analysis built upon a previous report published in January 2010.

The research is the only longitudinal analysis of its kind, based on in depth analysis of around 20 indicators comparing the performance of the four UK countries over the past two decades, from the 1990’s up to the latest point where comparable data was available (in some cases, 2012/13).


2014: comparing the four health systems of the UK

The Nuffield Trust and the Health Foundation published a second report in April 2014: The four health systems of the UK: How do they compare? The report explores the performance of the four countries in the NHS since the previous 2010 report, across a number of key indicators.

The research found that the performance gap between the NHS in England and the rest of the UK has narrowed in recent years, with no single country consistency ahead of the others. This is despite considerable policy differences between each country, such as England’s greater emphasis on patient choice and the use of private sector providers, and the rejection of competition in Northern Ireland, Scotland and Wales.

The report also analyses North East England as a separate region as a comparator to the devolved countries, because it shares so many characteristics with them.

View an infographic of the key analysis from the report, exploring spending on health care, number of general practitioners, waiting times for a procedure (hip replacement), and life expectancy between the five regions.

The research is the only longitudinal analysis of its kind, based on in depth analysis of around 20 indicators comparing the performance of the four UK countries over the past two decades


2010: funding and performance of health care systems in the four countries

The January 2010 report: Funding and performance of health care systems in the four countries of the UK before and after devolution, tracked the performance of the UK health services at three time points – 1996/7, 2002/3 and 2006/7. Performance was tracked against a number of key indicators, including expenditure, staffing levels, activity (outpatient appointments, inpatient admissions and day cases), and crude productivity of staff and waiting times.

This was the first time that such an analysis had been conducted. It was also the first time that the performance of the 10 English regions had been compared with the NHS in England as a whole and the NHS in each of the devolved countries.

Broadly, the report found striking differences in performance with some UK countries spending more on health care and employing greater numbers of health staff but performing worse on a range of indicators.

It also raised important questions about the accountability of the devolved administrations for their health services and the availability of comparable data that will allow differences in performance to be analysed in future.

Following the publication of the original version of the report we received confirmation from the Office for National Statistics (ONS) of inaccuracies in the ONS statistics resulting from them having been compiled on a different basis across the four nations. We would like to reiterate that this error was not the result of our analysis and research, which is conducted to the highest possible academic standards.

We issued a statement clarifying the situation at the time. We have now published revised versions of the research report and summary, which are available from the publications block in the right-hand column of this page.

Project outputs

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