Learning from the four UK health systems

Following devolution in 1999, the UK now has one National Health Service but four different versions of it. But hardly anyone seems to be paying attention to that fact. As a result, a huge opportunity is going to waste.

It is not just that England has gone down a road of applying more market-like pressures – particularly following Andrew Lansley's health reforms – while Scotland and Wales, in particular, have reverted to a more planned, managed, version of the NHS.

It is also that all four countries are facing exactly the same pressures in terms of heavily restricted finance, medical advances, ageing populations, a growing burden of often multiple chronic disease, and difficulties in coordinating health and social care.

Each faces, on the face of it, significant hospital reconfigurations. Each is trying to make quality a core focus of health care. Each is building clinical networks. Each is seeking public health answers to lifestyles that impact health and health care costs. And each is trying to resolve these issues by somewhat different routes.

Yet this natural 'experiment' or natural 'laboratory' for comparing and contrasting to learn ‘what works’ − or at least learn something about what works − is not being exploited, or to be more precise it is not remotely being exploited enough.

There are a whole bunch of reasons for that. Despite it being still, broadly, one NHS – at least when viewed from outside the UK – key data is often collected differently in the different countries, making comparison on outcomes difficult. There are huge political sensitivities around the issues. And there is a sense that many politicians in all four countries do not want questions about what works best either asked or funded, for fear that the answer may not be in their favour.

Today the Fund is publishing a brief paper that is essentially a call to arms, arguing that something should be done about that.

Sure there are difficulties in making comparisons – partly for the reasons outlined above – and there may be more to gain from narrower studies than from an attempt to answer a 'whole system' question about which approach to running the NHS works best.

But those difficulties do not prevent other international studies of how different health systems, or bits of health systems, work – even when the obstacles of finding comparable data and working with different cultures are far greater than within the UK.

One common health system with four different versions would normally be the sort of design model that health service researchers would die for, offering the opportunity for lessons that should interest politicians, managers, health service leaders, taxpayers and patients themselves. As the money gets ever tighter and the challenges ever greater, now is time for this opportunity no longer to be squandered.