This paper aims to probe the differences between the United Kingdom's four separate health systems. These systems, it argues, are diverging in terms of structures, management approaches, and the way social care relates to health.

https://www.kingsfund.org.uk/sites/files/kf/field/field_publication_summary/four-uk-health-systems-jun13.pdf

The Four UK Health Systems: Learning from Each Other

Governing healthcare: Finding meaning in a clinical practice guideline for the management of non-specific low back pain

ObjectivesTo examine the types of choices available to patients in the English NHS when being referred for acute hospital care in the light of the divergence of patient choice policy in the four countries of the UK.MethodsCase studies of eight local health economies in England, Scotland, Northern Ireland and Wales (two in each country); 125 semi-structured interviews with staff in acute services providers, purchasers and general practitioners (GPs).ResultsGPs and providers in England both had a clear understanding of the choice of provider policy and the right of patients to choose a provider. Other referral choices potentially available to patients in all four countries were date and time of appointment, site and specialist. In practice, the availability of these choices differed between and within countries and was shaped by factors beyond choice policy, such as the number of providers in an area. There were similarities between the four countries in the way choices were offered to patients, namely lack...

Divergence of NHS choice policy in the UK: what difference has patient choice policy in England made?:

NHS Contracts in England and Wales; changing contexts and relationships.

Backgrounds Choice of provider has been an important strategy among policy makers, intended, in part, to drive improvements in quality and efficiency of healthcare. This study examined the information requirements, and decision-making experiences and preferences of patients who have had surgery for gastrointestinal cancer, to assess the status of provider choice in current practice. Methods The single-item Control Preferences Scale was used to determine patients’ experiences and preferences when being referred for tests, and choosing where to have surgery. Participants used a Likert scale to rate the importance of 23 information items covering a variety of structures, processes and outcomes at the hospital level and the department level. Participants were recruited by post and online. Results 463 responses were analysed. Patients reported very low levels of involvement in provider choice, with their doctor deciding where they underwent tests or surgery in 77.0% and 81.8% of cases, respectively. Over two-thirds of participants would have preferred greater involvement in provider choice than they experienced. Of note, patient age and education were not associated with reported preferences. Information on how long patients with cancer wait for treatment, annual operative volume and postoperative mortality rate, as well as retained foreign bodies and infection rates were considered very important. Conclusions There was a substantial unmet desire for greater involvement in provider choice among study participants. Respondents attached particular importance to surgery-specific information. Efforts should be made to increase involvement of patients with gastrointestinal cancer in provider decisions, across primary and secondary care, to deliver more patient-centred care. The reported lack of patient involvement in provider choice suggests it is unlikely to be working as an effective lever to drive quality improvement at present.

https://qualitysafety.bmj.com/content/qhc/25/9/696.full.pdf?with-ds=yes

Do patients with gastrointestinal cancer want to decide where they have tests and surgery? A questionnaire study of provider choice

A comparative study of the construction and implementation of patient choice policies in the UK. Final report project 08/1718/147. Southampton: NIHR Service Delivery and Organisation programme,

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A comparative study of the construction and implementation of patient choice policies in the UK. Final report project 08/1718/147. Southampton: NIHR Service Delivery and Organisation programme,