Health policy and systems in the UK

There have long been subtle differences in the policies and organisation of the health and health care systems of the constituent countries of the UK, while they have pursued very similar goals. However, since political devolution starting in 1998, this ‘natural experiment’ has become ever more interesting as policies and high level system ‘logics’ have diverged. This presents an opportunity to evaluate different approaches to system maintenance and improvement such as the use of market-like incentives versus a planned health care economy. Nicholas Mays has been conducting a series of studies comparing the UK countries’ health care before and at intervals since devolution using publicly available performance data. There are indications that England, where a more market-oriented, competitive system of service supply has persisted, initially out-performed Scotland, which had abandoned such an approach after devolution, particularly on measures of efficiency and responsiveness. However, this gap had disappeared in latest analysis in 2014. Future research will examine the relative performance of the public health services and wider health system in each of the UK countries.

The Policy Research Unit on Commissioning and the Healthcare System (PRUComm) is based jointly at LSHTM, led by Stephen Peckham and Pauline Allen, and the Universities of Manchester and Kent. The analytical work of PRUComm supports understanding how commissioning operates and how it can improve services and access, increase effectiveness and respond better to patient needs; and of how elements of the English healthcare system interrelate. PRUComm uses a range of disciplines to undertake its work including political science and policy analysis, organisational economics and law. Examples of research undertaken include: Investigation of the development and operation of new GP-led Clinical Commissioning Groups, and investigation of the effects of the system wide changes introduced by the 2012 Health and Social Care Act in England.

The Policy Innovation Research Unit (PIRU) brings together experts in health and social care research primarily to undertake evaluations of innovative policies, frequently in the form of pilots. The Unit is funded by the Policy Research Programme of the Department of Health, which commissions its work. Evaluations cover the entire portfolio of policies for which the English Department of Health is responsible including health ser vices, social care and public health. Current evaluations include those of the Integrated Care and Suppor t Pioneers, the Social Impact Bond Trailblazers and the implementation of the UK Anti-Microbial Resistance Strategy. Recently completed projects include the evaluations of the Public Health Responsibility Deal, the General Practice Patient Choice Pilot, the Cold Weather Plan for England and the direct payments in residential care trailblazers.