Funding and performance of healthcare systems in the four countries of the UK before and after devolution

This report undertakes a completely new comparison of NHS performance in the English regions and the devolved countries of the UK.

Political devolution means there are now four National Health Services in the United Kingdom. The health services of England, Scotland, Wales and Northern Ireland are all funded by the UK taxpayer, but have developed different systems of governance and different methods of providing health care.

Funding and performance of healthcare systems in the four countries of the UK before and after devolution examines the impact of devolution in the four countries by studying a number of key performance indicators such as expenditure, staffing levels and waiting times, at three key points – 1996/7, 2002/3 and 2006/7. This is the first time such an analysis has been conducted. Broadly, the report finds striking differences in performance with some UK countries spending more on health care and employing greater numbers of health staff but performing worse in key areas.

This report provides a comprehensive comparative study of NHS performance across the four health services of the UK

The analysis confirms that, historically, Scotland, Wales and Northern Ireland have had higher levels of funding per capita for NHS care than England. The research suggests the NHS in England spends less on health care and has fewer doctors, nurses and managers per head of population than the health services in the devolved countries, but that it is making better use of the resources it has in terms of delivering higher levels of activity, crude productivity of its staff, and lower waiting times.

Some of these differences and trends may be because of historic differences in funding levels, which are not directly related to policy differences following devolution. But some will reflect the different policies pursued by each of the four nations since 1999, in particular the use in England of targets, strong performance management, public reporting of performance by regulators, and financial incentives.

Following the publication of the original version of the report we received confirmation from the Office for National Statistics 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. Available on this page are the revised versions of the research report and summary.

Suggested citation

Connolly S, Bevan G and Mays N (2010) Funding and performance of healthcare systems in the four countries of the UK before and after devolution. Research report. Nuffield Trust.