Is the NHS worse than healthcare in Europe, as Cameron claims?
contribution by Dr AlienfromZOG
Both David Cameron and Andrew Lansley have sought to justify the NHS reforms in various ways. In the Times today, Cameron says: “Already our health outcomes lag behind the best in Europe.”
Tories say that despite increased healthcare spending over the last ten years, the UK still has relative poor healthcare outcomes. But this is a case of the wrong diagnosis leading to the wrong prescription.
To quote the health secretary:
Modernising the NHS is a necessity, not an option, in order to meet rising need in the future, we need to make changes now. We need to take steps to improve health outcomes, bringing them up to the standards of the best international healthcare systems.
Writing in the British Medical Journal last week, John Appleby of the independent Kinds Fund explains why this analysis is completely flawed.
The full article is well worth reading and freely available, though this is a key excerpt:
The official ministerial briefing for the Health and Social Care Bill states that despite spending the same on healthcare, our rate of death from heart disease is double that in France.
Although statistics from the Organisation for Economic Cooperation and Development (OECD) confirm that in 2006 the age standardised death rate for acute myocardial infarction was around 19/100,000 in France and 41/100,000 in the United Kingdom, comparing just one year-and with a country with the lowest death rate for myocardial infarction in Europe-reveals only part of the story.
Not only has the UK had the largest fall in death rates from myocardial infarction between 1980 and 2006 of any European country, if trends over the past 30 years continue, it will have a lower death rate than France as soon as 2012.
These trends have been achieved with a slower rate of growth in healthcare spending in the UK compared with France and at lower levels of spending every year for the past half century.
Or to put it another way, the UK’s health outcomes are improving faster than other European countries, despite the fact that the UK’s health spending has only just reached the average European levels.
—
Dr Alienfromzog BSc(Hons) MBChB MRCS(Ed) DCH
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Reader comments
Spot on. The way Lansley and Cameron have denigrated the NHS to justify ‘modernisation’, aka privatisation/out-sourcing, is a disgrace and is spin beyond belief.
Also, the word ‘modernising’ is very Orwellian. If anyone can tell me why their plans are ‘modernising’, I’ll be impressed. If anything, they mean a return to pre-1945 health systems and pre-modern conditons for workers. Hardly ‘modern’.
The spending over the last ten years will take many more years to see fruitation. Healthcare and peoples health can not change in ten years, it will take much more. The last ten years spending was playing catch up over the previous 20 years of under investment.
What we do know is that Britain is the ONLY country in the industrialised world where wealth does not determine access to healthcare – a situation that no doubt galls the privilege loving tories?
http://www.guardian.co.uk/society/2010/nov/18/nhs-best-free-access-healthcare
As with heart attacks the NHS has also made very good progress on another common, and serious health condition – according to this item “death rates from breast cancer have fallen more dramatically in the UK than any other European county”
http://www.guardian.co.uk/world/2010/aug/12/uk-lowest-cancer-death-rate
The overall performance of systems is not easy to measure but we do know that there is a huge difference in expenditure when we look at the cumulative spend on health (over the last 50 years) if we compare the NHS to countries like France, Germany or Switzerland.
Cameron is making comparisons with Europe, but is importing a model from North America where average outcomes are poorer and where disparities in outcome are much higher.
The Tory propaganda would, however, have us believe that there is no alternative to their draconian measures. They say the NHS is worse than it’s counterparts in Europe – it may be but it was improving; they say that spending was out of control – spending did rise at the end of the last government but largely because of the banks. An expensive reform of the NHS is no guarantee of success; indeed part of the plans for hospitals that are deemed to be failing is takeover by private service providers.
The people are being lied to by a Tory-led coalition and are aided and abetted in that by a right-wing press. The scaremongering about Greece and Ireland has no relevance to our economy and the scaremongering about national debt has no impact on the credit of the UK with international markets (Borrowing as a proportion of GDP is one of the lowest of the G8).
The Tory political elite are ideologically strong but economically weak yet the shadow cabinet are afraid to challenge them with the progressive alternative for fear of being labelled pejoratively as a party of tax and spend. Contracting the economy by reducing public service provision will only boost welfare payments and consequently increases the future burden on the NHS through health problems associated with unemployment and deprivation. To promote growth we need to invest in the future. Increasing public spending with a sustained long-term programme of house-building (preferably socialised) and civil infrastructure construction is a guaranteed way of boosting the economy. This could be paid for with further quantitative easing at a lesser extent than that required for the banks. The further QE would have the side-effect of reducing the exchange rate for the pound, which will benefit export and attract international investment to the UK and therefore augment the economy. My prognosis? No major surgery required!
.
Cameron has been much quoted as saying the NHS will become unaffordable if it is not reformed.
That claim may or may not be convincing but he is noticeably silent on the next leg of the argument – namely, convincing us that Lansley’s proposed reforms are really what is needed to cure the NHS of its problems.
Is the NHS BETTER than healthcare in Europe? And should we just sit back and accept if the answer to that is no?
[8] are english footy teams better than german, french, spanish, and italian footy teams?
@7 Mark M,
Is the NHS BETTER than healthcare in Europe? And should we just sit back and accept if the answer to that is no?
Mark, that’s a complex question but it is one I’m happy to debate.
However, I think you are slightly missing the point.
David Cameron is expressly claiming that the outcome data shows the NHS is WORSE than comparable countries and therefore THESE reforms are what is needed.
The point is, the premise is flawed and the evidence is clear that the Government proposals will makes things worse. So in terms of an argument, it is very poor – the premise is flawed and it’s a logical fallacy.
That is not for one second to say that the NHS cannot be improved. It is to say, however that on the basis of an incorrect assertion, DC is trying to justify far-reaching and very damaging reforms.
I am just in the process of writing to my MP, essentially laying out the facts, as I understand them, in the hope that enough MPs will vote against this bill.
I do, however doubt it. And because of that, I fear for the NHS and I fear we are condemned to poor healthcare in the future – like the USA, only worse.
AFZ
Prostate cancer patients seem to do better in third world Libya than in the UK, if Mr Al-Megrahi is anything to go by.
Criticising the coalition for wanting to reform/modernise the NHS or any other public service is a bit rich considering Blair spend 10 years endlessly tinkering with every part of the public sector, to almost no discernable effect on outputs. The problem is people automatically conflate “increased funding” with better service when the two do not correlate.
In purely economic terms the NHS hasn’t been doing well for a while. Over the last decade, spending on it more than doubled, without a corresponding increase in output. NHS output actually peaked in 2005 and hasn’t moved since. And I don’t believe for a minute that the spending will somehow pay off in 20 years time, governments don’t spend money unless they think it will have an effect in the near term (i.e before the next election), and the NHS exists to treat illness now, not invest in health for the future.
@11 Matt,
Criticising the coalition for wanting to reform/modernise the NHS or any other public service is a bit rich considering Blair spend 10 years endlessly tinkering with every part of the public sector, to almost no discernable effect on outputs.
What makes you think I didn’t criticise some of the previous governments reforms? For the record, I think that much of what the previous government did was very good – the shift from fund-holding GP with a focus on competition to PCTs was a good move. (This is being effectively reversed by the Lansley Bill). The introduction of NICE was good. The massive increase in capital spending was definitely needed. The significant increase in the number of doctors and nurses were also much needed.
The over-use of crude targets was a problem. Not enough has been done to control drug pricing. Much of the reforms will have longer-term benefits but clinical priorites were also compromised to acheive measurable targets so that a political ‘win’ for the government could be achieved. A good example of this is how the 4-hour waiting limit target for A&E has been implemented.
That doesn’t change the fact that these reforms are bigger than what the last government did. And more importantly, they’re completely wrong.
You claim that there was no decernable effect on outputs. This is plainly ridiculous. I could quote number of operations or amount of ‘activity’ (to use the technical term) to you, which is much higher, but more useful I think are the words from the Audit Commission’s report “Healthy Balance” released in March of last year:
The health of people in England has improved over the past ten years. Life expectancy has increased, infant mortality has fallen. Government targets to
cut premature death from heart disease and stroke by 2010 have already been met.
It does go on to talk about areas that are still in need of improvement. Most notably health inequality. However, that doesn’t alter the fact that there has been a significant improvement in the national’s health.
So I come back to my original point. The comparison that Cameron is using with other European countries is totally misleading. Either he know’s this and is lying or he doesn’t know it and needs some education in intepretation of health statistics. Either way, it is very poor justification for reform. Furthermore, the reform proposed will make things worse rather than better.
Given that I know these things (or at least, I am well informed, well placed and well trained to hold the view I do) surely it would be wrong of me not to criticise the government for these proposed reforms.
AFZ
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John Appleby -chief economist -points out how Cameron & Lansely are massaging the figures to justify their NHS reforms: http://bit.ly/fM9P7M
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