Learning from the four UK health systems

After devolution in the UK, there are now four versions of one National Health Service. Hardly anyone is paying attention to this fact. A huge opportunity is being wasted.

Not only has England shifted to more market-like demands – especially after Andrew Lansley’s reforms in the health sector – but Scotland and Wales have also reverted to a more managed, planned version of NHS.

All four countries face the same challenges, including a lack of finance, medical advancements, an aging population, a growing burden from chronic diseases, and problems in coordinating social and health care.

On the surface, both face significant hospital reconfigurations. Each is trying to make quality the core focus of healthcare. Each builds clinical networks. Each seeks public health solutions to lifestyles that affect health and healthcare costs. Each is attempting to solve these issues in a slightly different way.

This natural “laboratory” or “experiment” for comparing and contrasting to learn what works, or at least to learn something about it, is not exploited or is only marginally used.

There are many reasons why. Although it is still, in general, one NHS, at least from the outside, key data are often collected differently by different countries. This makes comparisons of outcomes difficult. Political sensitivities are high around these issues. There is also a feeling that politicians from all four countries are afraid to ask or fund questions about the best way forward out of fear that they may not like the answers.

Today, the Fund publishes a short paper, which is essentially an appeal to arms, arguing for something to be done.

There are some difficulties with comparisons, partly because of the reasons listed above. However, it may be better to focus on a narrower study than to try to answer the question of which system approach is best for running the NHS.

These difficulties don’t stop other international studies on how different health systems or parts of plans work, even when obstacles to finding comparable data and working in different cultures are much greater than in the UK.

A common health system that has four versions is the kind of design that would make health service researchers die. It would offer lessons to politicians, managers, and health service leaders, as well as taxpayers, patients, and even the public. Now that money is getting tighter and challenges are increasing, it’s time to stop wasting this opportunity.

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