Two decades have passed since the devolution of social care policy, with key differences emerging between the UK’s four systems, but what impact have these differences had? This book presents for the first time research on the perspectives of social care policy makers on the four systems in which they operate and the ways in which they borrow from one another. Drawing on extensive interviews with national and local policy makers across the UK, the book raises vital questions about the role of ‘standardisation’ and ‘differentiation’ in social care, concluding that when given equal capacity to reform their respective systems, the regimes in each nation may take radically different shapes.

The devolution of social care policy has led to key differences emerging between the UK's four care systems. This book presents research on the perspectives of social care policy makers within the UK's four care systems, concluding that when given equal capacity to reform, the systems in each nation may take radically different shapes.

The devolution of social care policy has led to key differences emerging between the UK’s four care systems. This book presents research on the perspectives of social care policy makers within the UK’s four care systems, concluding that when given equal capacity to reform, the systems in each nation may take radically different shapes.

This report highlights key trends and variations in the delivery of healthcare across the four nations of the UK. Life expectancy varies significantly across the UK - from 75.9 in Scotland to 78.6 in England for men, and from 80.4 in Scotland to 82.6 in England for women. Spending on health services in the UK more than doubled in cash terms in the last decade. In 2010-11, despite devoting a higher proportion of total public spending to health, England spent the least on health per person. NHS staff has also increased over the last decade. Scotland has the most GPs per person (80 per 100,000 people in 2009 compared with 70 in England and 65 per 100,000 in both Wales and Northern Ireland). Scotland also has the most medical hospital staff and nursing, midwifery and health visiting staff per person. Comparable data on the efficiency and quality of healthcare are patchy. In 2008-09, average hospital lengths of stay varied from 4.3 days in England to 6.3 days in Wales. Hospital waiting times have fallen in all four nations in recent years, although there are notable variations in how long patients wait for common procedures. In 2009-10 waiting times tended to be lower in England and Wales. There have been significant improvements in levels of healthcare associated infections with rates of MRSA infection dropping by a third or more in all nations. The NAO considers that there would be value in the health departments in the four nations carrying out further work to investigate the variations in performance and identify how they can learn from each other

This review incorporates the views and visions of 2,000 clinicians and other health and social care professionals from every NHS region in England, and has been developed in discussion with patients, carers and the general public. The changes proposed are locally-led, patient-centred and clinically driven. Chapter 2 identifies the challenges facing the NHS in the 21st century: ever higher expectations; demand driven by demographics as people live longer; health in an age of information and connectivity; the changing nature of disease; advances in treatment; a changing health workplace. Chapter 3 outlines the proposals to deliver high quality care for patients and the public, with an emphasis on helping people to stay healthy, empowering patients, providing the most effective treatments, and keeping patients as safe as possible in healthcare environments. The importance of quality in all aspects of the NHS is reinforced in chapter 4, and must be understood from the perspective of the patient's safety, experience in care received and the effectiveness of that care. Best practice will be widely promoted, with a central role for the National Institute for Health and Clinical Excellence (NICE) in expanding national standards. This will bring clarity to the high standards expected and quality performance will be measured and published. The review outlines the need to put frontline staff in control of this drive for quality (chapter 5), with greater freedom to use their expertise and skill and decision-making to find innovative ways to improve care for patients. Clinical and managerial leadership skills at the local level need further development, and all levels of staff will receive support through education and training (chapter 6). The review recommends the introduction of an NHS Constitution (chapter 7). The final chapter sets out the means of implementation.

Equity and Excellence : Liberating the NHS: Presented to Parliament by the Secretary of State for Health by Command of Her Majesty