The impact of devolution on the health systems of England, Scotland, Wales and Northern Ireland is almost impossible to gauge due to a lack of information needed to make meaningful comparisons.
That is the view of a paper co-authored by The King's Fund and published today in the British Medical Journal. The paper, Effect of diverging policy across the NHS, says the government, Treasury, Parliament and a host of other bodies are missing out on potentially valuable lessons from the different approaches to health policy that have been adopted by each home country since devolution.
The authors warn that in areas such as NHS spending per capita, spending on hospital and community health services and spending on family health services, they were unable to make comparisons due to a lack of credible information.
The King's Fund Policy Director Jennifer Dixon, who co-authored the paper, said:
'There is a major health care experiment taking place at the moment with all four home nations adopting very different approaches to delivering healthcare. This has produced mixed results with England performing better in areas such as waiting times largely as a result of extra money, targets, tough performance management and probably the contestability of clinical services.
'With devolution came an opportunity to learn the lessons from these different approaches, but a worrying lack of information has made this virtually impossible. Given the billions spent on healthcare, it is alarming that we lack the reliable data we need to make meaningful comparisons of NHS performance across the four nations of the UK. Taxpayers across the UK cannot tell whether their money is being better used in England, Scotland, Wales or Northern Ireland.'
The paper analyses the health service across all four countries during the period 1996/97 and 2002/3, but found that only a few meaningful comparisons could be made. These include:
- Waiting times - between 1996 and 2002 England's waiting times for first outpatient appointment and elective admissions fell rapidly, while in Wales and Northern Ireland these statistics worsened. Because of the way waiting times statistics are collected in Scotland, it is not possible to compare performance there with other UK countries
- Across all countries, higher levels of healthcare spending have not necessarily resulted in improved health across their populations, indicating that the way resources are used may matter more than levels of funding
- The number of beds per head has fallen across all countries at the same time as availability of hospital beds has risen
Fellow co-author Gwyn Bevan, Professor of Management Science at the London School of Economics and Political Science, said:
'This research shows that although huge sums of money have been given to new methods of collecting information only very few comparisons can be credibly made. The methods of data collection need to be more carefully designed in order to make the information stand up to scrutiny.'
The paper further says that despite huge funding increases to the NHS over the examined period, there were only small rises in the number of clinical staff employed by the health services of each country.
Notes to editors:
1. For further information or interviews, please contact the King's Fund media and public relations office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. For out-of-hours enquiries, please contact 07774 218439 or 07831 554927. An ISDN line is available for interviews on 020 7637 0185.
2. The authors of the paper are:
- Arturo Alvarez-Rosete, Researcher, King’s Fund
- Gwyn Bevan, Professor of Management Science, Department of Operational Research, London School of Economics & Political Science
- Nicholas Mays, Professor of Health Policy, Health Services Research Unit, London School of Hygiene and Tropical Medicine
- Jennifer Dixon, Director of Policy, King’s Fund.
3. The King's Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through funding. We are a major resource to people working in health, offering leadership development programmes; seminars and workshops; publications; information and library services; and conference and meeting facilities.