The territorial bases of health policymaking in the UK after devolution

Abstract

For all that there is a well-entrenched sense of the differences among the different peoples of the UK, there has been surprising reluctance to accept the extent to which these differences translate into divergent public policy trajectories. That means the extent of policy divergence since devolution has been something of an uncomfortable surprise for many. Its speed, given the common heritages, similar organizations, shared problems, and pressures for convergence between the four systems might startle – in an increasingly globalized world (and medicine has long been cosmopolitan) their divergence is striking and explaining it important. If there is to be change in a mature welfare state such as that of the United Kingdom, it will most likely be through the accretion of such changes to existing systems. And, I argue, the changes reflect the distinct politics of place and the way policy makers, often insensibly, respond to their particular problems and debates in ways that vary territorially and produce territorial policy divergence that matters.

Keywords:

• Devolution
• Health Policy
• England
• Northern Ireland
• Scotland
• Wales
• UK

Acknowledgements

I would like to thank participants in the ECPR Standing Group on Regionalism, Edinburgh, October 2004, and in particular Michael Keating, Nicola McEwen and Kevin Woods for their comments; I would also like to thank Alan Trench and Guy Lodge for comments and help. This research was supported over four years by the Nuffield Trust and the Leverhulme Trust, and was only possible because of their willingness to sustain large research projects.

Notes

¹Northern Ireland, unlike the other three, got a Green Paper (DHSSNI, 1998) in the hope that its politicians would take up the challenge and perhaps even view it as an incentive to govern Services.

²The main other difference is that GP fundholding was much less common in Northern Ireland, Scotland, and Wales than in England, although there were significant concentrations around Edinburgh and Belfast. Use of the private sector by patients tired of NHS waiting lists or facilities followed the same pattern.

³I owe this point to Kevin Woods.

⁴See the ongoing research of Christopher Potter, University of Wales College of Medicine (see also, National Audit Office, 1996;Welsh Office and Welsh Health Planning Forum, 1989; and Owen, 2000).

⁵The most striking such bad report was compiled by the Welsh Institute for Health and Social Care. Memorably, only 31% of Welsh health system leaders said they would choose to rely on the Welsh health care system for the care of a loved one (Longley and Beddow, 2005: 9).

⁶Which can be followed at www.rpani.gov.uk.