There have been significant improvements in the health services in all four countries of the UK since devolution, a major report has found.
Tougher sanctions and targets in Scotland have led to improvements, however austerity has led to rising waiting times in Wales.
Despite policy differences in each country, devolution has led to a narrowing in the performance gap between England and the rest of the UK.
England has implemented a greater emphasis on patient choice and the use of private sector providers, however competition has been rejected by Northern Ireland, Scotland and Wales.
Since the previous study in 2010 which used data up to 2006/7:
- England performs marginally better across a number of key indicators, including amenable mortality rates, life expectancy and ambulance response times. But, the gap has narrowed on many indicators and differences between the countries are often small. Nurse staffing levels have been lower in England than in the other three countries over the period studied.
- Scotland shows a marked upturn in performance on indicators associated with targets and performance management, such as waiting times for planned surgery, which now broadly match England’s, and ambulance response times.
- Wales demonstrates improved performance on a number of indicators, but shows deteriorating performance on waiting times since 2010, with striking rises in waits for common procedures such as knee or hip operations. In 2012/13 a typical Welsh patient waited about 170 days for a hip or knee replacement compared to about 70 days in England and Scotland.
- Northern Ireland has improved performance on most indicators, but MRSA mortality rates remain higher than both England and Wales. There are no comparable waiting time data for Northern Ireland in recent years.
Today’s report is based on in-depth analysis of around 20 indicators, comparing the performance of the four UK health systems over the past two decades, from the 1990s up to the latest point at which comparable data are available (in some cases 2012/13).
Dr Jennifer Dixon, chief executive of the Health Foundation, said:
“It is very good news for the public that the quality of health care is improving across the UK. But what is also humbling for politicians is that so far no one policy cocktail seems to be more effective than another on NHS performance.
“This is despite all the rhetoric about the benefits or otherwise of introducing competition among providers. Clear targets and effective performance management can produce results, for instance, reducing waiting times, but we do know that this regime will only work in a small number of areas of performance.
“The progress of the NHS towards better quality of care depends on local conditions as well as the level of funding available. There is no shortage of enthusiasm and talent in the NHS, particularly at the coalface. Supporting local clinical teams is likely to be the best long term strategy to improve the quality of care.”
Dr Peter Carter chief executive of the Royal College of Nursing said there was “plenty of good news” in the report.
He said: “Seamless care linking hospitals to community services will only become more important as all four countries face up to the challenges of an older population and patients with multiple or long term conditions.
“Sadly, there are some significant warning signs here too. Wherever a patient is receiving care, staffing levels and skill mix need to be sufficient for that care to be safe. There are signs in this report that the staffing levels in England in particular have slipped in recent years, at a time when demand has risen.
“Health services in all four countries have been subject to policy and funding changes since 2000, and clearly differences have arisen. While this means that it can be complex to track performance, we believe that the fundamental priority is simple – give staff the tools to do the job, and health services will improve.”
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