For more than half a century, the NHS in England and Wales has been run on identical lines.

But 50 years or so years after Nye Bevan's dream of a national heath service came into being, Welsh devolution has begun to tailor the health service in the principality to meet the needs of Wales.

For the first time, service delivery is being significantly changed to reflect different needs:

Community Health Councils
Until the recent climbdown by the government this was one of the most obvious differences between England and Wales. Wales had decided to retain and strengthen CHCs, while England was determined to scrap them. In England, health secretary Alan Milburn is temporarily putting on hold what was one of the most controversial aspects of the health and social care bill.

"Right from the very beginning the assembly signalled its intention to keep and strengthen the 20 CHCs in Wales, and when the English national plan was published, I was told straightaway by the Welsh health minister, Jane Hutt, that CHCs would be retained," said Jane Jeffs of the Association of Community Health Councils in Wales.

She will present a paper this week outlining the ways in which CHCs will provide an effective patient voice. She and the association want more representative bodies with members selected through public advertisements to attract people from a variety of backgrounds and age groups.

Ms Jeffs would like to see CHCs becoming the equivalent of citizen's advice bureaux in health terms, with much greater resources and a much higher public profile. In England the proposals for replacing CHCs included providing independent advocacy services (IAS) that would support patients when they wanted to make complaints.

Health authorities
The decision to abolish the five existing health authorities in Wales by 2003 was taken earlier this year. Under the plans, the assembly itself will take direct control of its health responsibilities through a newly created health and well-being partnership council. The existing day-to-day functions of the health authorities will be distributed among 22 local health groups (LHGs) that were originally sub-committees of the authorities.

The LHGs are similar to the primary care groups in England and are expected to work on health improvement programmes, monitor the quality of primary care, and look at ways hospital and community services are commissioned. The groups also provide a valuable link with social care and one LHG chairman is a director of social services, while a second is led by a nurse.

Abolition of the health authorities means that what is seen as an unnecessary layer of bureaucracy is taken away and replaced with LHGs that are, according to Ms Hutt, more accountable and democratic than what has gone before. It also proposes staff representation on NHS boards.

Last month in England, Mr Milburn announced the government's intention of reducing the present 95 health authorities to 30 with the aim of working towards ending the centralised control of the NHS. The merging of two-thirds of the health authorities would be completed by 2004, with many of their responsibilities devolved to primary care trusts (PCTs).

Free prescriptions
The assembly has also taken the lead with its decision that from April 1 this year everyone under 25 is entitled to free prescriptions charges and free dental check-ups. Around 88% of prescriptions in Wales are free and this age group is not considered to place a much greater burden on the health service - the additional cost is expected to be around £3m.

Cross border "drug runs" are being monitored as the policy is not based on residential qualification and there are already concerns that people living on the borders of Wales, particularly those with chronic conditions such as asthma and acne who need medication on a regular basis, will opt for pharmacists in Wales where prescriptions are free.

Prescription price freeze
The assembly has frozen all prescription prices in Wales so pharmacists in border areas have to operate a two-tier charging system where cost depends on whether the address of the GP is in England or Wales. The gap in costs is small, but will increase unless England also freezes its charges.

Dentistry
Regulations to introduce free dental examinations to people under 25 and those aged 60 or over have also been brought in by the assembly. People aged 60 or over will also be entitled to optical examinations, and those under 25, who are often likely to have a limited income, will be encouraged to maintain sound dental health at a time when irreparable damage might otherwise be caused. Dental fissure sealant programmes have been introduced for children in areas of high dental decay.

The maximum dental charge for Wales has been frozen at £354, whereas in England, it was increased to £360 last month.

Health promotion
Future health promotion targets are expected to differ between England and Wales because of varying needs. Wales, for example, has 10% more cancer and 19% more heart disease than England, but less HIV, Aids and Tuberculosis. It also has one of the largest elderly populations in Europe, and one of the smallest ethnic populations.

A 30-point strategy for health promotion in Wales has been launched by the Welsh assembly. Its launch comes amid concern about health problems and inequalities in the principality. There have been warnings that health in Wales remains poor compared with England and that the rates of adult smoking and drinking are increasing.

There has also been a deterioration against the health targets set for low birth weight, back pain, arthritis and dental decay in young children. The new strategy aims to reduce inequalities and improve health and quality of life.

A new smoking cessation service, a community nutrition initiative, and new guidance on sex education in schools are among the strategy's priorities. An accreditation scheme for health promotion materials and a national website are also planned. The strategy is being circulated for comments.

Children's commissioner
Wales has taken the lead in the UK with the appointment of a commissioner who has wide ranging responsibilities covering social care and health, including young people in hospitals and in GP surgeries. Neither England nor Scotland have commissioners and the appointment in Wales was in response to child abuse in the principality.

Quality and standards
While further elements of the NHS are being adapted for Welsh needs, some remain common to England and Wales, like, for example, the national institute for clinical excellence (Nice), and the commission for health improvement (Chi).