Devolution and health in the UK: policy and its lessons since 1998

Br Med Bull. 2016 Jun;118(1):16-24. doi: 10.1093/bmb/ldw013. Epub 2016 May 5.

Abstract

Introduction: Since devolution in 1998, the UK has had four increasingly distinct health systems, in England, Northern Ireland, Scotland and Wales.

Sources of data: Secondary literature and authors' own research since 1998.

Areas of agreement: From a similar starting point, there has been a considerable distancing of the four health systems from each other in policies, priorities and organization.

Areas of controversy: The comparative efficiency and quality of the different systems as well as the wisdom of their greater or lesser reliance on integration and competition.

Growing points: Better and more comparable public data would be useful, as would consideration of potential devolved lessons for UK policy.

Areas timely for developing further research: Comparisons of organization and performance at levels more detailed than whole systems; analysis of the resilience and management of different systems in a context of budgetary austerity; analysis of the politics behind policy decisions.

Keywords: England; NHS; Northern Ireland; Scotland; Wales; policy.

Publication types

  • Review

MeSH terms

  • Decision Making, Organizational
  • Delivery of Health Care / economics
  • Delivery of Health Care / organization & administration*
  • Dissent and Disputes
  • England / epidemiology
  • Health Care Reform* / organization & administration
  • Health Policy
  • Humans
  • Interinstitutional Relations*
  • Leadership
  • Marketing of Health Services / organization & administration
  • Northern Ireland / epidemiology
  • Policy Making
  • Politics*
  • Scotland / epidemiology
  • State Medicine* / economics
  • State Medicine* / organization & administration
  • Wales / epidemiology