Research published this week by the Nuffield trust has reignited the debate over the value of health service targets.

Its comparison of the NHS’s performance in the four nations of the UK finds that the service in England spends less and has fewer NHS staff per head than in the devolved countries, but is making better use of its resources in delivering higher levels of activity, productivity of staff and lower waiting times.

Of course, the normal caveats apply regarding the comparability and age of the data and the fact that the measures do not reflect quality of outcomes.

But as the purse strings tighten - and the public and media become ever more critical of any public spending they regard as wasteful - all four nations must be able to demonstrate value for money.

Alarmingly, Nuffield director Jennifer Dixon warns that there is a lack of comparable data that allows differences across the UK to be analysed in future.

And, while the Conservatives argue that productivity in the English NHS has fallen, they must be careful that if they form the next government, their removal of all “politically motivated” targets does not unravel demonstrable performance to date.

Four nations: was England’s approach to the NHS on target after all?