New HiT for United Kingdom (Northern Ireland)

The new HiT (Health Systems in Transition) health system review for United Kingdom (Northern Ireland) has just been released. The organization of the NHS in Northern Ireland is radically different to that in England, despite superficial similarities. A crucial difference is the commissioning of hospital services. In Northern Ireland, unlike in England, there is no competition between trusts, and this has two implications: funds to hospitals are distributed geographically, based on a formula designed to ensure horizontal equity, and there is no market pressure on individual hospitals and control is bureaucratic, with the emphasis being on consultation and cooperation among health and social care bodies. Without competition, effective control over the system requires information and transparency to ensure provider challenge, and a body outside the system to hold it to account. The restoration of the locally elected Assembly in 2007 has created such a body, but it remains to be seen how effectively it will exercise accountability.