NHS performance: how do the four nations compare?

We now have a new UK government who have pledged to “build an NHS fit for the future”. However, the UK government is only responsible for health within England, with the administrations in Scotland, Wales and Northern Ireland responsible for health within their nations.

Naturally it’s often tempting to compare the NHS in the four nations, and we have checked claims like these from politicians in the past. But in reality, the four services have different targets and different ways of measuring performance, making comparisons between them difficult, and sometimes impossible.

The Office for National Statistics (ONS) is working to make it easier to compare nations in the future. In the meantime, we’ve taken a look at some comparisons you can make: in planned care, A&E performance and satisfaction. 

Planned care

There is no straightforward way to compare waiting lists across all four nations. We can make some comparisons between Wales and England, and between Northern Ireland and Scotland, as they report performance in similar ways. Just remember that we are talking about the number of cases here (or “pathways”), which is not the same as the number of people waiting, because some people are waiting for more than one thing.

Analysis by the ONS has been able to compare the number of cases per 100 people, which shows higher rates in Wales than in England.

In Scotland and Northern Ireland, waiting time is split by stage. These can’t just be added together to get full pathways, as some politicians have done in the past. The two nations also use different policy definitions so they aren’t directly comparable, but the ONS have said that these differences alone won't be the reason why numbers differ substantially between the two nations.

Northern Ireland has not published comparable data since September 2023 as they are introducing a new patient system, so the comparison here is less recent than for Wales and England.

The only way to get an idea of how waiting compares across England, Wales and Scotland is from an ONS survey conducted between October 2023 and March 2024, in which people were asked: “Are you currently waiting for a hospital appointment, test, or to start receiving medical treatment through the NHS?” More people in Wales (29%) than in England (25%) or Scotland (22%) gave the answer yes.

It’s important to note that this survey and the NHS statistics are measuring different things. The two sources have different definitions of a waiting list, and their data is collected in different ways. Statistics for England, Scotland and Wales come from NHS patient records, whilst the ONS survey is self-reported, so people are likely to include a much wider range of things that they might be waiting for, such as follow-up appointments, or mental health or community services.

Accident & Emergency

It is possible to compare A&E performance for England, Wales and Scotland, but not for Northern Ireland. The three nations all have the same target that at least 95% of attendances should be admitted, transferred or discharged within four hours of their arrival at any type of A&E department. We have shown data for major A&E units, used for serious and life-threatening emergencies, as this is the best way to compare data between the three nations.

Satisfaction

We’ve previously written about public satisfaction with the NHS in Great Britain, based on the British Social Attitudes survey (BSA), which doesn’t cover Northern Ireland.

In the latest survey, 24% of respondents from England said they were ‘very’ or ‘quite’ satisfied with the NHS, higher than Scotland (22%) and Wales (21%). However, there are wide confidence intervals around the results for Scotland and Wales especially, which means there’s a reasonable chance that there might not be a difference between the three nations.

We also have information about people’s satisfaction with GP services collected by the ONS for England, Wales and Scotland. Between October 2023 and March 2024, 50% of respondents in Scotland said they found it easy or very easy to access their GP practice, compared with 43% in England and 39% in Wales. The lower percentages in England and Wales do not differ significantly from each other, so again there’s a reasonable chance that there might not be a difference between the share of people in the two countries who would give these answers. However, in Scotland, significantly more people did say they found it easy to access their GP.

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This article was written by a Health Foundation staff member on secondment during the election campaign, and edited by Full Fact staff.