2024 marks 25 years since significant social policy powers in the UK were devolved to Scotland, Wales and Northern Ireland. In the early years of devolution, studies of health policy divergence flourished, but there has been markedly less scholarly attention paid to its drivers and consequences in the last decade. Devolved health policy is particularly interesting because there was comparatively little divergence before devolution, and it was the most substantial policy area (in budgetary terms) to be devolved when the Scottish Parliament was (re)created.
Assessments of the impact of the first decade of devolution vary, with Greer (2016) arguing that ‘four increasingly distinct health systems’ were emerging, while Hellowell and Smith (2012) argued that intra-UK experimentation often led to re-convergence, as policy approaches deemed successful in one UK nation were adopted elsewhere. More recently, we’ve seen what we might expect to be enabling conditions for divergence, including opposing political parties in Government across the four systems, and an expansion of devolution to include aspects of fiscal policy; previously identified as constraining health policy divergence.
Yet, the potential learning from intra-UK health policy divergence is still harnessed too little. Indeed, in 2023, the 75th anniversary of the NHS, the British Academy published ‘Lessons from the history of British health policy’ that excludes any mention of Scottish, Welsh or Northern Irish devolution from its timeline of key legislation, and makes substantive mention only of public health policy divergence.
We are delighted to have been funded by the Social Policy Association to explore Scottish health policy divergence through two witness seminars in May 2024. We’re bringing together key people involved in two landmark reforms (the abolition of the internal market, and the ban on smoking in public places), and will publish the proceedings of these discussions open access to document these reflections on the reforms for future research. If you’re interested in hearing more about the project, please get in touch with Kat Smith and Ellen Stewart.
References:
- Primary care in the UK: understanding the dynamics of devolution, Exworthy, 2001
- Four Way Bet: How devolution has led to four different models for the NHS, Greer, 2004
- The Politics of Health in Scotland after Devolution, Nottingham, 2000
- Devolution and health in the UK: policy and its lessons since 1998, Greer, 2016
- Beyond Rhetorical Differences: A Cohesive Account of Post-devolution Developments in UK Health Policy, Hellowell & Smith, 2012