Political devolution means there are now four National Health Services in the United Kingdom. The health services of England, Scotland, Wales and Northern Ireland are all funded by the UK taxpayer, but have developed different systems of governance and different methods of providing healthcare.

Funding and Performance of Healthcare Systems in the Four Countries of the UK Before and After Devolution examines the impact of this by studying key performance indicators for the NHS in England, Scotland, Wales and Northern Ireland at three time points – 1996/7, 2002/3 and 2006/7. The report also undertakes a completely new comparison of NHS performance in the English regions and the devolved countries. This is the first time such an analysis has been conducted.

Key statistics for the NHS in the four countries are examined before and after devolution. Performance was tracked against a number of key indicators, including expenditure, staffing levels, activity (outpatient appointments, inpatient admissions and day cases), crude productivity of staff and waiting times. Broadly, the report found striking differences in performance with some UK countries spending more on health care and employing greater numbers of health staff but performing worse when it comes to a range of indicators, such as waiting times and crude productivity of staff.

The analysis confirmed that, historically, Scotland, Wales and Northern Ireland have had higher levels of funding per capita for NHS care than England. The research suggests the NHS in England spends less on healthcare and has fewer doctors, nurses and managers per head of population than the health services in the devolved countries, but that it is making better use of the resources it has in terms of delivering higher levels of activity, crude productivity of its staff, and lower waiting times.

Some of these differences and trends may be because of historic differences in funding levels, which are not directly related to policy differences following devolution. But some will reflect the different policies pursued by each of the four nations since 1999, in particular the greater pressure put on NHS bodies in England to improve performance in a few key areas such as waiting and efficiency, through use of targets, strong performance management, public reporting of performance by regulators, and financial incentives.

This report will be of interest to healthcare leaders and policy-makers across the UK, as well as academics and students interested in healthcare and health policy, and in UK politics generally following devolution.

Since the publication of our comparative study of UK health performance, we have received official confirmation from the Office for National Statistics that an official figure obtained from the ONS using data provided by Scotland, which was used in our report (published on 20 January), was incorrect. The inaccuracy for this figure resulted from the ONS statistics having been compiled on a different basis across the four nations. We would like to reiterate that this error was not the result of our analysis and research, which is conducted to the highest possible academic standards. We have amended this figure and provided updated graphs. We have also issued a statement clarifying the situation. We are in the process of amending the report.

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