Do targets matter? A comparison of English and Welsh National Health priorities.

National priorities and performance management regimes in the National Health Services of England and Wales diverged following devolution, most notably with respect to the use of waiting time targets, which have been progressively strengthened in England but were abandoned in Wales in the immediate post-devolution period. We analyse routine data collected over a six-year period from three English and one Welsh hospital trust close to the English-Welsh border to ascertain whether: (a) there is evidence of differential performance over time that relates to the country where the hospital is located; (b) within each hospital, there is evidence that English and Welsh patients faced different waiting times. Over the period the English hospitals recorded increased levels of activity, undertook proportionately more day case activity, and mortality rates fell. Activity levels remained constant in Wales, the proportion of day case activity fell, proportionately more non-elective patients were admitted, and mortality rates rose. There is partial evidence that English patients faced lower waiting times than their Welsh counterparts and were more likely to be admitted within a target waiting period. The stronger performance management regime operating in England appears to have contributed to higher levels of performance in the English hospitals over the period.