Funding and performance of health care systems in the four countries of the UK

Area of work:

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. We continue to 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.

We published a major report in January 2010 into the funding and performance of the health care systems of the four countries of the UK (see more on this below). In partnership with the Health Foundation, we are conducting a further examination of the performance of the four UK health services for publication in 2013.

As part of this we will publish updates on the different policy approaches being pursued by the home nations – these will be accessible from this project page.

2010 Nuffield Trust report

Our 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), 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.

The divergence of policies between the health services of the four UK nations provides a fascinating natural experiment.

Dr Jennifer Dixon, Chief Executive, Nuffield Trust, 18 Mar 2010

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.