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ABSTRACTAlthough the NHS operates throughout the United Kingdom, it is organised, and services are planned, differently in each of the four countries: England, Wales, Scotland and Northern Ireland. Curiously, the differences are generally either overlooked or dismissed as irrelevant. Yet their persistence gives the lie to the view that the NHS is a highly centralised, monolithic entity. Moreover, they illustrate the paradox of considerable diversity within a unitary state. This paper examines some of the variations that exist, noting that recent changes in the organisation of health services have done little to modify these differences. Indeed, in regard to developments in the private health sector and to approaches to planning and priority-setting, the differences may, in future, become greater. For such a compact entity, UK policy analysts are surprisingly uninformed about practices occurring around them. The paper argues that there is a need for researchers and policymakers to pay more attention to intra-UK variations such as those evident in the NHS and to devise ways of ascertaining their impact on service delivery and, if possible, on performance.

Although the National Health Service (NHS) operates throughout the UK, it is organized differently in England,, Wales, Scotland, & Northern Ireland. While the differences are generally overlooked, they serve to contradict the view that the NHS is a highly centralized, monolithic entity. Some of the variations that exist are examined as they reflect historical differences in health care in the four countries, eg, in provision of elderly care, in the care of mentally ill persons, & in the use of NHS hospitals for private practice. For such a compact entity, UK policy analysts are surprisingly uninformed about the practices occurring around them; it is argued that there is a need for more comparative analysis of health-care systems in the UK, with the goal of improving performance. 6 Tables, 85 References. Modified HA.

Cover -- Title Page -- Copyright Page -- Contents -- Foreword -- About the editors -- List of contributors -- Acknowledgements -- Introduction -- Setting the agenda for public health -- Part 1: The UK, Europe and international -- Introduction -- 1 Public health in Scotland: the dividend of devolution -- 2 Public health in England -- 3 Public health in Wales -- 4 Public health in a changing Ireland: an all-island perspective -- 5 Public health policy making in a disunited kingdom -- 6 European public health -- 7 International public health -- Part 2: Key issues in public health policy -- Introduction -- 8 New social democratic politics of public health in England today -- 9 Inspecting, informing, improving: public health within the Healthcare Commission -- 10 Public health in the English regions -- 11 Local government and the health improvement agenda -- 12 Getting fully engaged with local communities -- 13 Health and sustainable development -- Part 3: Priorities for health -- Introduction -- 14 Tobacco: current issues -- 15 Food: time to shift from classical to ecological public health -- 16 Healthy childhood and a life-course approach to public health -- 17 Sexual health: the challenges -- 18 Mental health -- 19 Alcohol -- 20 Transport -- 21 Work and health: what direction for occupational health practice? -- 22 Work and health: an overview of policy -- 23 Public health and genetics -- Part 4: Public health in practice -- Introduction -- 24 Developing the public health workforce -- 25 Making joint Director of Public Health posts work -- 26 Primary care as a gateway to public health -- 27 The role of public health nursing -- 28 Dental public health -- 29 The contribution of the acute sector to promoting public health -- 30 Health protection and environmental public health in the UK and the rest of Europe -- 31 Academic public health