If the NHS really is the envy of the world, why don’t countries copy it?

Mark Littlewood from the Institute of Economic Affairs asks 20th December in the Times: If the NHS really is the envy of the world, why don’t countries copy it?

Image result for envy cartoon

As Christmas wishes go, mine is pretty modest. Of course, a complete end to war, disease and famine across the globe would be wonderful. But if I can’t have that, maybe I can have something that should, in theory, be a little easier to achieve. I just want an open, grown-up and serious debate about whether we are absolutely sure that the NHS truly is the best healthcare system known to mankind.

I confess to being something of a sceptic. My gut instinct tends to be that we have at least as much to learn from the rest of the world as we do to teach it. So I would probably enter the discussion from a minority position.

Indeed, defenders of the status quo make some truly spectacular claims. According to David Cameron, the National Health Service is “one of the greatest achievements of the 20th century”. Aneira Thomas, the first person born under NHS care, insists it is the “envy of the world”, a sentiment apparently supported by 56 per cent of the UK population in opinion polls.

If these assertions are even half-true, they raise a rather awkward question. Why haven’t our European neighbours sought to replicate our cherished system? They have had 68 years to stare in wonder across the English Channel, turning an ever more fluorescent shade of green as their jealousy over the sheer brilliance of the NHS overwhelms them. Yet not one leading European country has taken our blueprint and copied it. Are these foreigners incredibly stupid, amazingly callous or just too bone idle to embrace a great idea when they see one? Alternatively, have they studied the facts and decided that they are much better off with the more market-orientated, less centralised healthcare policies each of them has chosen to adopt?

A glance at the statistics suggests that Johnny Foreigner isn’t as dim as some might think. Presumably, a useful starting point is to judge how good a system actually is at preventing people from dying.

If we could somehow replicate the survival rates from common forms of cancer that they manage to achieve in the Netherlands, nearly 10,000 fewer Brits would die each year. If we could get as good as the Germans, we would save about 13,000 lives annually. If we could somehow aspire to understanding whatever magic health formula the Belgians have stumbled upon, we could get that figure up to 14,000. That’s the equivalent of saving the entire population of Bolton every decade merely from improved cancer treatment. Looking at survival rates overall, the UK is about on a par with the Czech Republic and Slovenia, countries where average income is less than half of ours.

It is true that affluent western European countries tend to spend a little more than the UK on healthcare. But, crucially, they spend it in different ways. They run insurance-based systems and allow for competitive markets and even — horror of horrors — profit-making. The Dutch have no state-owned hospitals, no state hospital planning and no taxpayer subsidies to any hospital. In Germany, less than half of hospitals are run by the public sector. The Belgians even sometimes require a modest payment to see a GP. To different degrees, but across the board, competition in providing the best healthcare is encouraged.

Crucially, all these countries manage to guarantee universal healthcare coverage. The poor are not left without quality treatment. The fear that they might be seems to be behind much of the love for the National Health Service, but such concerns are misplaced. Through a mixture of means-tested subsidies and compensation schemes, the Europeans seem able to ensure that every citizen is properly covered.

Just because you want the state to guarantee access to something does not mean that the public sector needs to be the actual provider. We want to ensure everyone in Britain has access to food, but that doesn’t mean it is sensible to nationalise Tesco, Waitrose and Asda. Neither does our desire to ensure that all people can be clothed lead us to conclude that Marks & Spencer, Next and Debenhams should be amalgamated into a single company and then run by a Whitehall ministry. Yet we seem to have a blind spot when it comes to health, assuming that a gigantic government industry with 1.5 million employees is the best way to go.

The trick, of course, is to make sure that everyone is given the wherewithal to enable them to participate in the marketplace and then let the wondrous dynamics of competition weave their magic in providing high quality at an acceptable cost. In the healthcare arena, it is a trick that our continental neighbours are much better at performing than we are.

On an individual level, it is understandable that so many Brits feel warmth towards the NHS. Ourselves, and our loved ones, will very often visit a doctor or a surgeon with a health problem and find through the brilliance of medicine and the diligence of highly trained professionals that we are swiftly cured. Even if the worst happens, we console ourselves that medical experts gave it a really good shot. We don’t stop to ask whether the treatment would have been better if we lived in, say, Berlin or Rotterdam.

My Christmas wish is that we should start asking ourselves exactly that and in an unsentimental and clear-headed fashion. It might be comforting to kid ourselves that we have pioneered and maintained the greatest healthcare system on the planet, but that doesn’t make it remotely true. To believe that the centralised, state-run National Health Service is the best possible mechanism for curing the sick and keeping people alive is simply at odds with the facts.

Indeed, it’s about as far from reality as believing that a plump, bearded man on a reindeer-driven sleigh has left all those presents under the tree.

Mark Littlewood is director-general of the Institute of Economic Affairs

Sir, Mark Littlewood is to be congratulated for introducing a degree of reality into the debate about the NHS (“If the NHS is the envy of the world, why don’t any European countries copy it?”, Business, Dec 20). Is it really beyond our politicians to set aside party differences and establish a far-reaching and independent commission to examine the health and social care needs of the UK over the next 30 years? Such a commission should examine how care is successfully delivered and funded elsewhere, and ask searching questions as to whether we can reasonably expect the NHS and local government to match the best that is available, or if different delivery and funding solutions are needed.

Will Lifford

East Keswick, W Yorks

Sir, The elevation of our NHS to “holy cow” status is over-simplistic (letter, Dec 22). By the same token, Mark Littlewood’s article treats the NHS as a business, equating it to food supply and clothing. Surely the clue is in the title — it is a service not simply a business. That said, this is not the same as regarding it as a sacred cow. As a large, complex organisation there are doubtless areas that can be (and are being) improved without abandoning the principle of universal healthcare. Having this year been diagnosed for a second time with cancer I have been extremely grateful that during all this time, with five operations, six weeks as an in-patient, six weeks of radiotherapy and countless tests and clinics, I have never once had to worry once about my ability to pay for this excellent treatment.

By contrast, during my working career I lived abroad in a number of countries, notably the US, which did not have a comparable healthcare system, and where the ability to pay was a very real issue.

The time we should really worry is when the first question you are asked when visiting your GP is not “what is your date of birth?” but “what is the long number on your debit card?”.

John Young

Richmond, N Yorks

Sir, Mark Littlewood concludes that “To believe that the centralised, state-run National Health Service is the best possible mechanism for curing the sick and keeping people alive is simply at odds with the facts”, yet puts forward few facts to justify this assertion. The “factual evidence” he provides is a comparison of the extent of expected live expectancy in various countries after diagnosis and treatment for cancers. He notes that if the NHS could replicate the performance of the Netherlands, Germany and Belgium, death rates would fall and up to 14,000 fewer Britons would die each year. The UK, he says, “is about on a par with the Czech Republic and Slovenia, countries where average income is less than half ours”.

What he omits to say is that life expectancy as a whole is lower in Germany, Denmark and Belgium than in the UK; that these countries spend a higher proportion of their GDP on healthcare than the UK does; and that life expectancy in Slovenia and the Czech Republic is significantly lower than that achieved by Britons.

Alexander Johnston

Syston, Leics

Sir, Mark Littlewood asks questions that need answering, but J Wesley Harkcom (letter, Dec 22), along with many politicians, seems not to understand why the public are so loyal to the NHS. In 2014-15 the NHS gave superb care to my wife in her terminal illness, all the way through the ambulance service, Truro A&E, the neurological surgery unit at Derriford in Plymouth, the multiple services provided by Truro hospital, the neurological rehabilitation unit in Hayle, St Austell Hospital, Mevagissey surgery and the many Cornwall social services who, together with the NHS, enabled my wife to stay at home, enjoying life to a remarkable extent, until her death.

Anecdotal evidence suggests that our very good experience is common. This explains the public’s loyalty to the NHS. Misunderstandings get in the way of the sensible debate suggested by Mark Littlewood, who understands this loyalty.

Gerald Hingley

St Austell, Cornwall

This entry was posted in Community Health Councils, Patient representatives, Political Representatives and activists, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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