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NHS performance better in England than other UK countries, finds major new report

  A new study into the NHS has found England is spending less but performing better than Scotland, Wales and Northern Ireland.

Professor Gwyn BevanGwyn Bevan, Professor of Management Science at LSE's Department of Management, is one of the authors of the report .

The study examines the performance of the health service across the four countries of the UK before and after devolution, and found striking differences.

Some countries are spending more on health care and employing greater numbers of staff but performing worse when it comes to a range of indicators, such as waiting times and crude productivity of staff.

The report, published by independent charity the Nuffield Trust, looks at three time points - 1996/7, 2002/3 and 2006/7.

It also examines the performance of the ten English regions and compares them with the NHS in England as a whole and the NHS in each of the devolved countries in 2006/7.

This is the first time such an analysis has been conducted. 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. 

The main findings are:

  • Historically Scotland, Wales and Northern Ireland have had higher levels of funding per capita for NHS care than England. However, the research suggests the NHS in England spends less 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.
  •  Scotland has the highest levels of poor health, the highest rates of expenditure, the highest rates of hospital doctors, GPs and nurses per capita, and yet it has the lowest rates of crude productivity of its staff and the lowest rates of inpatient admissions per head of population in 2006/7.
  • In 2006, Wales had the lowest rate of day cases but the highest rate of outpatient attendances, while Northern Ireland had the lowest rate of outpatient attendances but the highest rate of inpatient admissions and day cases.
  •   The performance of Wales and Northern Ireland in key measures of waiting has been poor compared with England (Scotland's waiting times could not be compared with those of England, Wales and Northern Ireland at the three time points because they were measured in a different way). By 2006, virtually no patients in England waited more than three months for an outpatient appointment, whereas in Wales and Northern Ireland 44 per cent and 61 per cent of patients did. By 2006, virtually all patients in England who needed inpatient or day case treatment were seen within six months, while in Wales and Northern Ireland 79 per cent and 84 per cent of patients waited longer than this.

The report looks only at statistics that can be measured in the same way in the English regions and the devolved countries at three selected time points. It is possible that the comparative statistics that are available fail to capture some important dimensions of performance. The report recommends that other dimensions, such as staff and patient experience and health outcomes, should therefore be the subject of further research. However, it also concludes that previously published studies do not point to consistent higher levels of quality of care in the devolved nations that might partly offset the lower crude productivity levels of staff relative to England.



1. Funding and Performance of Healthcare Systems in the Four Countries of the UK Before and After Devolution was written by Professor Gwyn Bevan, Professor of Management Science, London School of Economics & Political Science, Sheelah Connolly, Research Fellow, Queen's University Belfast and Professor Nicholas Mays, Professor of Health Policy, London School of Hygiene and Tropical Medicine

21 January 2010