The recently commissioned review of international healthcare systems by the Centre for Workforce Intelligence has a profound significance for healthcare management and the delivery of nursing and medicine within the UK (Cookson, 2012). This review will analyse and compare contrasting international healthcare systems of different providers across the UK—identifying the key factors affecting the delivery of healthcare. This commission must be viewed in relation to the ‘Nicholson Challenge’ (Hawkes, 2012), which requires savings of £21 billion to fund increased demand over the next four years. These efficiency savings are required to be found through better ways of working within current NHS law and regulation (Department of Health (DoH), 2010a; DoH, 2010b; Hawkes, 2012). The main agenda will be staff substitution —substitution of a higher graded practitioner by a lower graded practitioner. However, the greater opportunity is for healthcare assistants (HCAs) to become more professionally empowered.