Devolution and health policy: A map of divergence within the NHS - 1st annual update
April 2007
Mapping divergence
It is worth noting that 1998 provides the baseline for departure from a UK NHS. England is recognised as the country that has moved furthest, and has been the most active, having been through several phases of reform.
The first reform concentrated on standards under Frank Dobson, on targets and governance under Alan Milburn and competition, markets and choice under John Reid. Patricia Hewitt’s focus is currently on reconfiguration and changing the way patients relate to health services.
Superficially, it could be argued that the aims in England are the same as those in Scotland and are not dissimilar to stated ambitions in Wales and Northern Ireland. All wish to streamline the acute sector and provide more care in community settings. There are clear commonalities in broad policy objectives across the UK however policy aims are being pursued within different political contexts. The policy communities within each nation are employing entirely different levers and philosophies. For example, in Scotland, trusts have merged into single health systems, while England is encouraging competition to produce more responsive care. These differences have implications for the ways doctors work and are represented within systems.
In this report, we have mapped the terrain of devolution according to differences in the political context, strategic direction, use of organisation, changing financial flows and incentives, and varying views of professionals. The following sections consider these issues in the UK context before examining national differences.