NHS III - this time it's another post about the NHS

Why do we need to modernise? According to the Prime Minister, the NHS is "second best". The Government's white paper states that they aim to 'once again make the NHS the envy of the world' and 'success will be measured, not through bureaucratic process targets, but against results that really matter to patients ' It is very difficult to find recent data, but given that the last World Health Organisation (WHO) report comparing data was 2007, well into the New Labour government it seems reasonable to use it. I have also used data from Organisation for Economic Co-operation and Development reports (OECD), which also only provide data up to 2007. So, given these provisos, how second rate is the NHS? 

In 2007, WHO* ranked the UK as having the 18th best health care in the world. Top was France, and second was Italy. Also above the UK were a number of small countries such as Andorra, Malta, Singapore and Oman, which don't really bear much comparison. 18th place was achieved at a cost of 8.2% of Britain's GDP. This was the 41st highest amount and compared to France's 11.2% and Italy's 8.9%. All of the developed countries that were higher in the league spent a far larger percentage on health than the UK, with the exception of Japan and Spain, who spent the same as the UK. Notably, the UK performed much better than many developed countries with much higher spending. Switzerland's 11.4% got it 20th place, Germany's 10.7% brought in at 25th place and most  damning of all, The USA's 15.2% got it placed 37th, just behind Costa Rica and Dominica. 

If we look at the expenditure on health per head of the population the NHS again comes out of the stats very well. Britain, spent $2990, the 18th highest amount, on health per person. Top placed France spent $3593, 20% more,  German (25th) $3619, 21% more, Switzerland (20th) spent $4469, 95% more and the USA (37th) spent $7285, an astonishing 144% more. Once again Spain (7th) out performed the NHS with expenditure of $2658 per person, 12% lower and Italy $2701 (2nd) also had a 10% lower. However, if we take into account the cost of living in each country, according to the OECD stats, it would make Spain the same as the NHS and Italy more expensive. All of the other countries would remain relatively more expensive than the NHS for a worse ranking. 

So what about outcomes? Once again it is difficult to get good data. The last OECD report  on what are known as 'preventable deaths' was 2004. In the developed world, these are the sort of thing that are often associated with risk-taking such as smoking, drug abuse and daring to cross a road. I suppose there is a strong cultural quality to this indicator but I would argue it demonstrates how well the broader aspects of health care, such as education, are working. In 2004 we were in 12th place. Once again the USA was lagging behind and so was Austria, who the Prime Minister has been held up as a shining example of good practice recently. We also beat the WHO's top ranked country, France. No country, spending less per head, when cost of living is taken into account, had a better ranking. 

The Coalition have said that there will be 'a relentless focus on clinical outcomes. Success will be measured, not through bureaucratic process targets, but against results that really matter to patients – such as improving cancer and stroke survival rates.' In 2009 some alarming statistics from an OECD report were widely reported in the British press. 'The sick man of Europe' - said The Telegraph, who stated that, 'heart and cancer survival rates were amongst the worst in the developed word.' A WHO bulletin, published soon afterwards, argued that these results were an example of 'non-transparent framing' which was explained as data provided as a 'deliberate tactic to manipulate or persuade people.' 

These are the same stats that the Coalition have been throwing around to prove that the NHS is 'second best'. It certainly sheds a new light upon the white paper when it says, 'Patients will have access to the information they want, to make choices about their care'. In the bulletin, Gerd Gigerenzer. an expert in 'risk literacy' from the Max Planck Institute in Berlin examined the apparent chasm between UK (35%) and US (60%) survival rates of 5 years after being diagnosed with colon cancer. In fact as, Gigerenzer demonstrates, the mortality rate is 'roughly' the same. The difference in so called 'survival rates' is actually largely explained by the widespread screening in the US which leads to massive over diagnosis of non-progressive cancers. For those categories reported by the press, the UK was placed 12th overall, once again ahead of the curve in relation to our relative funding.

The Coalition continue to stress that Britain is not getting the appropriate results in return for the increased spending over the last thirteen years. After years of under-investment there has been a massive increase in spending, from 6.6% to 8.8% of GDP, which the government has repeatedly told us is in line with the EC average. That might be the case, but if we compare spending with the older, more developed EC members or those from Scandinavia, from my reading of the information, Britain still spends less (%) than all the other countries. According to the OECD, even Spain overtook us in 2008. 

Is the NHS 'second best'? Well, it probably is. But, I hope, that this post has demonstrated that it is more to do with continued under-funding rather than with the structures or productivity of the staff. Even with the limitations of the data it seems safe to conclude that we are getting excellent value for money from the NHS. The dedicated staff punches above its weight across a range of indicators. These are staff who  regularly put in that little bit more because they feel valued by their employers and the community and recognise that health is more than a job. These are the staff who will shortly be sold down the river in exchange for higher share dividends. 

Philosopher George Santayana defined fanaticism as "redoubling your effort when you have forgotten your goal." It seems apt, in these circumstances because if there is one firm conclusion I can draw from my reading; it is that the involvement of the private sector does not guarantee any great leaps in productivity or quality of outcomes. As we have seen over the last couple of years, the private sector is not even that good at making money. Outcomes are obviously important but the NHS is important for other reasons. It is a glue that binds our society and can't be measured in perecentage points. Sadly, the Tories are too blind to see that these rather intangible qualities mean that the NHS is still the envy of the world. 

So how to modernise? Well, if we want to knock France off the top of that league - we'll have to spend a lot more money, but I suspect, not as much as France. 

*WHO’s assessment system was based on five indicators: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system’s financial burden within the population (who pays the costs).