Devolution and divergence in UK health policies Dr Jennifer Dixon Director Nuffield Trust IPPR 2...

Devolution and divergence in UK health policies

Dr Jennifer DixonDirectorNuffield Trust

IPPR2 February 2009

Background

Divergence in policy in NHS has always existed Before 1998 fundamental political unity Now distinctive trajectories

Scotland

High status medical leaders closely connected to policy

Communitarian values Main battles between Labour and SNP

Scotland

Purchaser-provider split abolished Integration of system into 14 geographical health

boards– No ‘payment by results’

– No competition (no plurality of providers)– No ‘practice-based commissioning’

Focus: chronic disease; public health and reducing inequalities; waiting(Kerr 2005)

Free long term personal care Prescription charges reduced (£5 -1/4/08)

Levers: Scotland ‘professionalism’*

5

providerperformance

Central directive

Regulation

MarketLocal accountability

Professionalism

* Scott Greer

Wales

Main battles between labour and Plaid Cymru

Communitarian values

Wales

2003 reorganisation of commissioning into 22 local health boards co-terminous with local authorities

Emphasis on public health and reducing inequalities Purchaser-provider split maintained, but current

Labour-Plaid Cymru coalition (2007) committed abolishing it

Number of Health Boards and Trusts to reduce No PbR, no foundation trusts Prescription charges abolished 1 April 2007

Levers: Wales ‘limits of localism’*

8

providerperformance

Central directive

Regulation


Professionalism

* Scott Greer

Northern Ireland

Politics: sectarian representation Little interest in health Change slow

Northern Ireland

Purchaser- provider split remained GP fundholding abolished only 2003 2005-6 UK government began to make decisions Since restoration of devolution that halted that

change Now plans to merge all 4 Health Boards into one

and reduce the number of Trusts to five Managers free to make decisions (unless large)

Levers: N. Ireland ‘permissive managerialism’*

11

providerperformance

Central directive

Regulation


Professionalism

* Scott Greer

England

Politics: (new) Labour 2000-2006 major changes Purchaser-provider split Autonomy for providers, plurality, competition

and choice, PbR PCT and practice-based commissioning Regulation Devolution of power Central directive

Levers: England ’markets into managerialism*

13

providerperformance

Central directive

Regulation


Professionalism

* Scott Greer

Comparing NHS performance across the UK

Sensitive Data comparisons not straightforward (who

is interested in VFM across the UK?) Old debates about level of funding for need

(Barnet Formula)(Add in Scott’s graphs on funding and

morbidity)

England 96-7

England02-3

Scotland96-7

Scotland02-3

Wales96-7

Wales02-3

N. Ireland96-7

N. Ireland02-3

Waiting

Inpatient

<6 month 74.9 80.6 na na na 21 20.6 18.4>12 month 2.7 0 na na 9.9 15.9 17.1 22.0Outpatient

<6 month na 100 na na 94.1 67.6 80.7 61.4

% public satisfied

inpatient 51 49 61 58 63 60 67 84outpatient 50 51 64 60 63 55 70 88general practice

77 72 81 73 79 68 83 90

Devolution and divergence in UK health policies Dr Jennifer Dixon Director Nuffield Trust IPPR 2...

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