Devolved NHS improving but differences remain, study finds

11 Apr 14
Health services in all four nations of the UK have improved significantly since devolution, a study by the Nuffield Trust and Health Foundation has found

However, researchers identified some problems, primarily a rise in waiting times in Wales since 2010, with a typical Welsh patient waiting on average 100 days longer than a typical English patient.

The research, the only longitudinal analysis of it kind, found that the performance gap between the NHS in England and the rest of the UK had narrowed in recent year, with no single country consistently ahead of the others.

Commenting on the findings, Andy McKeon, senior policy fellow at the Nuffield Trust, said: ‘Our study period coincided with the biggest sustained injection of cash the four health systems have ever seen, so it’s perhaps unsurprising that staff numbers have increased and performance has improved.

‘But 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 frontrunner on health system performance.’

England was found to be performing marginally better across a number of key indicators including mortality rates, life expectancy and ambulance times. However, England’s lead over other UK nations has narrowed and nurse-staffing levels have been lower in England than in the other three countries.

Scotland showed a marked upturn in performance on indicators associated with targets and performance management, such as waiting times for inpatient treatment and ambulance response times. Scotland is now broadly in line with England on these measures.

In Wales, the trust noted ‘striking’ rises in waiting times since 2010 for common procedures such as knee and hip operations.

Northern Ireland had improved performance on most indicators, but MRSA mortality rates remained higher than in both England and Wales.

The study also considered the North East region of England as a comparator to the devolved countries. It found that the North East had benefited from higher investment than the average for England, and was now spending similar amounts per head to Scotland – £2,150 per head in 2012/13, compared to £2,115 in Scotland and £1,912 in England.

There were also marked improvements in treatment rates, hospital staffing levels, mortality rates and life expectancy in the region.

McKeon commented: ‘The North East’s remarkable progress on reducing avoidable deaths and improving life expectancy suggest that local conditions, such as funding and the quality of staff are the real determinants of health service performance.

‘Only time will tell if the four countries’ progress made to date will be sustained as austerity starts to bite. But Wales’ lengthening waiting times should set alarm bells ringing amongst policymakers when considering its possible impacts.’


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