Spending alone has failed to cut NHS waiting lists

The first comparison of NHS performance in the four countries of the UK has revealed that patients in England get quicker treatment, delivered more efficiently and cheaply, than those in Scotland, Wales and Northern Ireland.

The secret of England's success is the Government's policy of setting targets, such as the 18-week maximum wait for hospital admission, backed up with tough carrot-and-stick management, researchers say. They found that Scotland, Wales and Northern Ireland spent more and had more doctors and nurses per head, but had longer waiting times and lower hospital admissions than England.

Waiting times were slashed in England during the first decade of the Labour government, and the number of patients treated soared. By 2006, virtually all English patients who needed admission to hospital were treated within six months. Today, almost all patients are treated within 18 weeks of a referral by their GP.

But in the other countries, most patients waited longer than six months for treatment – 79 per cent in Wales and 84 per cent in Northern Ireland in 2006. Comparable figures for Scotland were not available. Since devolution in 1999, when the governments in Scotland, Wales and Northern Ireland took over the running of the NHS, performance in their countries has languished.

The findings, from a study published today by the influential health policy think-tank the Nuffield Trust, expose the gaps in the quality of NHS care across the UK. But the study also highlights the parties' different approaches to the health service for the coming election, by demonstrating the success of targets such as the 18-week maximum wait for in-patient hospital admissions in England.

The Tories are committed to abolishing NHS targets, which David Cameron has described as "wasteful and counter-productive". Labour has said it will retain key targets.

At the launch of the Tory party's health policy in 2008, Mr Cameron said health staff were "ticking boxes" rather than ensuring the best outcomes for patients. He attacked targets, saying they had increased bureaucracy and distorted priorities for little clinical benefit, and proposed phasing them out in favour of outcome measures for cancer, heart disease and stroke.

Health experts questioned his analysis but lacked the evidence to challenge it – until now. The Nuffield Trust study, by Professor Nicholas Mays of the London School of Hygiene and Tropical Medicine, covers the first 10 years of Labour rule, from 1996-97 to 2006-07.

In 2006, the NHS in Scotland spent 6 per cent more per head than the North-east of England, with which it is demographically comparable. It also had 14 per cent more doctors, 50 per cent more nurses and 75 per cent more managers. Yet the North-east treated 50 per cent more in-patients, 40 per cent more day cases and 18 per cent more outpatients.

Jennifer Dixon, director of the Nuffield Trust, said: "A key question for the NHS in all four countries is whether value for money is being obtained. Some of the differences reflect the greater pressure in England to improve performance via targets." But Nigel Edwards, director of policy at the NHS Confederation, representing NHS trusts, said the results did not show which country had the best health system. Targets "are only one amongst a variety of management tools, he said."