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NHS performance gap narrows across the UK

Friday, 11 April 2014

The performance gap between the NHS in England and in the rest of the UK has narrowed in the last decade despite considerable policy differences, according to research carried out by the School.

Patient in bedThe study found that there have been significant improvements in the performance of the health services across all four countries, with particular progress linked to tougher sanctions and targets in Scotland from 2005, but since 2010 waiting times in Wales have risen as austerity has set in.

Since political devolution in 1999, there has been increasing policy divergence between the health systems of the four countries of the UK.  This raises questions as to whether health system performance is improving and at the same or different rates across the UK as a result.

The new report finds that the performance gap between the NHS in England and in the rest of the UK has narrowed in the last decade with no country consistently ahead of the others. Differences in policy, such as England’s greater emphasis on patient choice and the use of private sector providers, and the rejection of competition in Northern Ireland, Scotland and Wales, have not yet seemed to produce obvious differences in performance at the system level.

Report lead author, Professor Nicholas Mays from the London School of Hygiene & Tropical Medicine, said: “What is interesting is that, despite hotly contested policy differences in structure, targets, competition, patient choice and the use of non-NHS providers, no single country is emerging as a consistent front-runner on health system performance.   There is little obvious sign of the benefits or otherwise of introducing competition among providers in England.  By contrast, it is clear that targets and effective performance management can produce results, for instance, in reducing waiting times.  England and Scotland both show this.  However, this regime will only work in a small number of areas of performance.”

The report is based on in-depth analysis of around 20 indicators, comparing the performance of the four UK publicly financed health systems over the past two decades.

On spending on healthcare, the study finds:

And on health care performance:

The authors also highlighted the importance of improving the range of comparable data that are collected in the future. Professor Nicholas Mays said: “In analysing the health services in the four countries, we have had to rely on a limited and diminishing set of comparable data, which makes it ever harder to make meaningful comparisons. This risks leaving policymakers in the dark when it comes to designing changes that lead to higher quality care. It is therefore important to continue to have routinely published comparable data, so that each country is able to see how their policies are working, and can be held to account for the performance of their health services.”

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Image: Elderly patient in hospital room Credt: Fotolia/araraadt

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