Devolution and health in the UK: policy and its lessons since 1998

Introduction: Since devolution in 1998, the UK has had four increasingly distinct health systems, in England, Northern Ireland, Scotland and Wales. Sources of data: Secondary literature and authors' own research since 1998. Areas of agreement: From a similar starting point, there has been a considerable distancing of the four health systems from each other in policies, priorities and organization. Areas of controversy: The comparative efficiency and quality of the different systems as well as the wisdom of their greater or lesser reliance on integration and competition. Growing points: Better and more comparable public data would be useful, as would consideration of potential devolved lessons for UK policy. Areas timely for developing further research: Comparisons of organization and performance at levels more detailed than whole systems; analysis of the resilience and management of different systems in a context of budgetary austerity; analysis of the politics behind policy decisions.