Britain´s National Health Service
“SICKO”, link the latest film from the left-wing American agitpropagandist Michael Moore, has already drawn a lot of comment for its favourable comparison of health care in Cuba with that in the United States. But Mr Moore does not reserve all his praise for the tiny Communist island. He lavishes admiration on Britain's National Health Service, presenting a vision of helpful staff and generous treatment.
Britons themselves might doubt details of this assessment. In the past decade the government has increased spending on the NHS at a record rate, but the political pay-off has been abysmal. Polls show that people now reckon the Conservatives have better policies on health than Labour does. The number telling pollsters that the NHS has become worse since 1997 greatly exceeds those who say it has improved. On May 23rd Patricia Hewitt, the health secretary, fought to survive a vote of no confidence in the House of Commons.
Yet a recent report from the Commonwealth Fund, a health-policy think-tank in America, seems to side with Mr Moore. Comparing health care in six developed countries, it ranks Britain top. Germany comes second, followed by Australia and New Zealand in joint third place, and then Canada. America is last. Britain has seized the top spot after coming third in the two previous surveys, in 2004 and 2006. link
The report is a welcome antidote to unthinking pessimism about the NHS, but its rosy view is open to question. The survey uses 69 indicators to rank the countries in five areas: quality, access, equity, outcomes and efficiency. Offering free health care to all, the NHS does unsurprisingly well on equity, but it comes fourth on health outcomes and access. What pushes it into top place overall is that it ranks first on quality and efficiency.
On both of these counts, the scoring is debatable. Britain gets the best mark for quality even though it has the joint-worst score for the proportion of patients reporting an infection in hospital. This seems a more important failure than coming last, as Canada did, in prompting doctors by computer to give patients a test result. Yet both indicators are given the same weight.
The efficiency rating is based on an eclectic range of indicators, such as health-care spending as a share of GDP and whether patients visit hospitals' emergency departments for conditions that could have been treated by family doctors. The individual comparisons may be revealing, but the sum of the parts does not measure efficiency, which is how effectively a system turns inputs into outputs.
Perhaps most important, the indicators are skewed towards the services of family doctors. Britain has long won plaudits for the primary care delivered by its GPs. The real worries have been about hospitals, especially the long waiting times for elective operations. Although excessive waits have been slashed, there are still almost 700,000 people on the waiting list.
And now it looks as if Labour's reforms in primary care are backfiring. A new contract for GPs pushed up their average pay by 23% in its first year, though their workload dropped by more than five hours a week between 2004 and 2005. Practices open on Saturdays are a thing of the past.
Gordon Brown, the prime minister to be, has promised to improve access to GPs at weekends and in the evenings. He will have to do more. However the NHS ranks internationally, what counts at home is that Labour has got poor value for the extra money poured into it.
Is the health service really so good?, The Economist May 24th 2007
The NHS is on the brink of collapse and cannot be saved unless Gordon Brown intervenes when he becomes prime minister to give doctors the authority to organise a recovery, the leader of Britain's 33,000 hospital consultants will claim today link
Jonathan Fielden, chairman of the British Medical Association's consultants committee, will tell Mr Brown: "Political meddling has brought the NHS to its knees. Unshackle the profession, give us back the health service, and we will rebuild it. Fail to do so and you will rightly be condemned for destroying the best piece of social capital the country has ever had." (...)
The service suffered from too little strategic direction and too many ministerial policy initiatives. It had become "a distorted skeleton". The government diverted billions of pounds from improving efficiency to create an internal market in which hospitals competed for patients. "The excessive use of private firms to provide NHS services has been costly, disruptive and has fragmented care. The independent sector should only be used where the NHS needs it, not thrust into its midst like a carelessly placed hand grenade." (...)
John Carvel NHS is on brink of collapse, say consultants June 6, 2007
Britons themselves might doubt details of this assessment. In the past decade the government has increased spending on the NHS at a record rate, but the political pay-off has been abysmal. Polls show that people now reckon the Conservatives have better policies on health than Labour does. The number telling pollsters that the NHS has become worse since 1997 greatly exceeds those who say it has improved. On May 23rd Patricia Hewitt, the health secretary, fought to survive a vote of no confidence in the House of Commons.
Yet a recent report from the Commonwealth Fund, a health-policy think-tank in America, seems to side with Mr Moore. Comparing health care in six developed countries, it ranks Britain top. Germany comes second, followed by Australia and New Zealand in joint third place, and then Canada. America is last. Britain has seized the top spot after coming third in the two previous surveys, in 2004 and 2006. link
The report is a welcome antidote to unthinking pessimism about the NHS, but its rosy view is open to question. The survey uses 69 indicators to rank the countries in five areas: quality, access, equity, outcomes and efficiency. Offering free health care to all, the NHS does unsurprisingly well on equity, but it comes fourth on health outcomes and access. What pushes it into top place overall is that it ranks first on quality and efficiency.
On both of these counts, the scoring is debatable. Britain gets the best mark for quality even though it has the joint-worst score for the proportion of patients reporting an infection in hospital. This seems a more important failure than coming last, as Canada did, in prompting doctors by computer to give patients a test result. Yet both indicators are given the same weight.
The efficiency rating is based on an eclectic range of indicators, such as health-care spending as a share of GDP and whether patients visit hospitals' emergency departments for conditions that could have been treated by family doctors. The individual comparisons may be revealing, but the sum of the parts does not measure efficiency, which is how effectively a system turns inputs into outputs.
Perhaps most important, the indicators are skewed towards the services of family doctors. Britain has long won plaudits for the primary care delivered by its GPs. The real worries have been about hospitals, especially the long waiting times for elective operations. Although excessive waits have been slashed, there are still almost 700,000 people on the waiting list.
And now it looks as if Labour's reforms in primary care are backfiring. A new contract for GPs pushed up their average pay by 23% in its first year, though their workload dropped by more than five hours a week between 2004 and 2005. Practices open on Saturdays are a thing of the past.
Gordon Brown, the prime minister to be, has promised to improve access to GPs at weekends and in the evenings. He will have to do more. However the NHS ranks internationally, what counts at home is that Labour has got poor value for the extra money poured into it.
Is the health service really so good?, The Economist May 24th 2007
The NHS is on the brink of collapse and cannot be saved unless Gordon Brown intervenes when he becomes prime minister to give doctors the authority to organise a recovery, the leader of Britain's 33,000 hospital consultants will claim today link
Jonathan Fielden, chairman of the British Medical Association's consultants committee, will tell Mr Brown: "Political meddling has brought the NHS to its knees. Unshackle the profession, give us back the health service, and we will rebuild it. Fail to do so and you will rightly be condemned for destroying the best piece of social capital the country has ever had." (...)
The service suffered from too little strategic direction and too many ministerial policy initiatives. It had become "a distorted skeleton". The government diverted billions of pounds from improving efficiency to create an internal market in which hospitals competed for patients. "The excessive use of private firms to provide NHS services has been costly, disruptive and has fragmented care. The independent sector should only be used where the NHS needs it, not thrust into its midst like a carelessly placed hand grenade." (...)
John Carvel NHS is on brink of collapse, say consultants June 6, 2007
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