Europe not America

Yerp: The Final Countdown for the NHS?

This week sees the publication of a very important report by the Taxpayer’s Alliance on NHS performance compared with those of our European neighbours.

Up till now NHS debate has tended to be polarised between the “40 million uninsured” under USA healthcare system, and our “at least everyone has a right to equally (bad) treatment under the NHS”. In Britain we have tended to value equality and universal access very highly, at expense of quality of service both in terms of effectiveness and accessibility.

Now there are many major criticisms of the American healthcare system, but its key flaw is that insurance companies can pick and choose who they take on. In other words those who need healthcare cannot get insurance to pay for it.

So on Dr Rant we’ve done the comparison of NHS vs USA healthcare, because we’ve often been asked “What about the European systems?”, not least by that naughty young scamp DK. Well, up till now we haven’t had much information about these. But there is no longer an excuse for our ignorance on this following two important new publications. One is the Taxpayer’s Alliance new report “Wasting Lives” and the other is Nick Seddon’s important new book “Quite Like Heaven: options for the NHS in a consumer age.” (Civitas)

It is clear from these sources that our European neighbours have managed to achieve a combination of universal access, decent accessibility to doctors, treatments, and investigations, and effective (It works) medical (it is medicine after all) autonomy (doctor-patient interaction works). Fundamentally, it can be argued that the NHS is not as effective pound-for-pound as our European neighbours.

The NHS has suffered a “Triple Nationalisation” of funding, allocation and provision. In Europe they don’t have this.

We have a centralised bureaucratic monolith that is not giving anyone, be they doctors, patients, managers or politicians or taxpayers, what they want. It costs a lot yet no one gets value, or feels valued by this system. It’s a miserable monopoly.

The Europeans get round our problems, and the American’s problems in three ways.

They have compulsory social insurance- you have to pay, and the insurance companies have to take you. Certain basic provisions are mandatory. The government defines the mandatory minimum but it does not directly raise the money.

Secondly they have multiple providers of care. There is no national monopoly employer and there is the possibility for unsatisfied employees to move elsewhere and for dissatisfied customers to move elsewhere. This means hospitals are run by people who want to run hospitals, and to survive, they need to provide. In the UK neither the staff nor the patients can escape the system very much (NHS is >90% of UK healthcare provision- my option to set up privately and thrive is currently very limited). The patients can move from town to town, and see someone different, but it’s still the same old NHS in crumbling old workhouse hospitals, or gimcrack plainly flimsy investment newer hospitals.

Thirdly they have devolved regions and districts that make decision right for their areas. In the NHS our new PCT chief executive is not local, not representative of his area, and in fact is the DH’s man in Rantingshire. As David Nicholson, the NHS Chief Commisar, has said “The job of chief execs is to implement government policy, not to debate it.” What would happen if we brought health care back under local authority jurisdiction? It would certainly make local councils matter rather more.

(Privately a lot of DH civil servants are very unhappy with current government policy and are praying for a change.)

So in these reports we find several suggestions to get the UK away from its miserable dependence on the monolithic, hidebound and bureaucratic NHS.

Maybe in the end a combination of doctors and patients will finally put a rocket under current NHS management and both sides could free themselves to work well with each other. The expansion of NHS management, for no clear purpose, under current structures is picked up in both these reports. These reports certainly provide additional strength to our model of “The Management Spaceship”- the proposition that if we sent ALL the NHS managers and DH civil servants on a one way ticket to Mars, it would be so much the worse for the Martians. The rest of us would get on better, and would feel no need to send a rescue mission to bring any of them back.

Gordon Brown’s pouring of billions of pounds of taxpayer’s money into the NHS has been squandered. Like the Wizard of Oz, he stands exposed as a weak vascillating little man hiding behind a screen:

"Argument weak - Shout louder! Spend more!"

The publication of these two reports significantly increases our knowledge of available, effective options to achieve the desired goals of medical effectiveness, accessible services and universal coverage. They are to be welcomed for doing this.

We wonder what Devil's Kitchen will make of this. Hopefully he won't choke on his corn flakes (much).

And just as we have needed to get an Italian coach to run the England football team, we need to admit we can learn something from our European neighbours about how to run a health service. Bloody Hell. Those damn krauts, dagos, frogs, naked Volvo-drivers and watchmakers might know something we don’t.

Oh, and they don’t have polyclinics and noctors either. Strange that.