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

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.