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Social Policy Review 19Analysis and debate in social policy, 2007$
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Karen Clarke, Tony Maltby, and Patricia Kennett

Print publication date: 2007

Print ISBN-13: 9781861349415

Published to Policy Press Scholarship Online: March 2012

DOI: 10.1332/policypress/9781861349415.001.0001

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One, or four? The National Health Service in 2006

One, or four? The National Health Service in 2006

(p.32) (p.33) Two One, or four? The National Health Service in 2006
Social Policy Review 19

Stephen Peckham

Policy Press

This chapter identifies a continuing divergence in 2006 between the four national health services within the UK as a result of devolution. Different solutions are emerging to common problems across England, Wales, Scotland, and Northern Ireland about how to ensure both responsiveness to local need and equity of provision. While the solution within the English NHS has been a continued reliance on market mechanisms and a central role for individual patient choice, the other three countries within the UK have adopted approaches in which there is a greater role for central planning, organisational partnerships, and professional engagement, giving a different role to patient choice. In all four contexts, there is a tension between allowing policy to be made at the local level to suit local circumstances, and maintaining some degree of central control over healthcare provision through target setting and performance management. It is argued that the different solutions offered in these national contexts offer an interesting natural experiment, in which alternative approaches to common problems can be evaluated against each other.

Keywords:   national health services, social policy, health policy, UK, devolution, public health, England, Wales, Scotland, Northern Ireland

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