Policy divergence is defined as a category of policies and strategies where significant differences can be identified between Scotland, Wales, Northern Ireland and England as a consequence of decisions by the devolved administrations. These policies fall short of major innovations or totally distinct policies, but diverge in significant ways. The main examples in this category fall into the health category plus other examples from social care, education and equal opportunities.

Health structures and governance

In the early years of devolution the organisation of the NHS was a key matter of debate for the devolved administrations – WAG's first request for Wales-only legislation related to a restructuring of the NHS, which was eventually passed as part of a general UK bill in 2003. This created a dual structure for the NHS in Wales, but a flatter structure than in England. There were 14 NHS trusts, 12 covering hospitals and two specialist trusts for cancer and ambulances. Twenty-two local health boards were responsible for primary healthcare and commissioning secondary health services and were coterminous with local authorities in Wales. There was no strategic health tier as in England. Three regional NHS business centres were set up but their role was supportive rather than directive for modernisation, continuous improvement and inter-agency cooperation. Within the NHS Wales structure were a number of specialist centralised bodies including: Health Commission Wales, which commissioned specialist services on an all-Wales basis; the Wales Centre for Health to improve health in Wales; the Health Care Inspectorate; and a National Leadership and Innovation Agency (WAG 2008b). The dominant thrust in this organisation of health services was described as reflecting localism and as a distinctive Welsh approach (Greer, 2004). The system was locally responsible, had local councillor representation on local health boards and local councils working in partnership with the NHS. The introduction of 22 local health boards coterminous with local authorities has been described as providing a very effective platform for developing strong community partnerships and had become a valued way of working (WAG, 2005a, p 38). However, the proliferation of local bodies, 60 in all, for the delivery of health and social care, did raise difficulties. Localism brought with it pressure on resources and the local health boards were small for commissioning purposes. Seven NHS trusts merged into three and groups of local health boards formed consortia for some services.