On 6 June 2011 I wrote a blog post that has gained what seems to be a life all of its own. The social media sharing data gives some indication of that:
The blog had the title 'The NHS — a stunningly cost effective supplier of high quality healthcare'. I reproduce it below. But what it says is that people want and need evidence that their instincts - that the NHS works and that we're getting extraordinarily good value for money from it - are right. And they are.
I have enormous reason to be grateful to the NHS, throughout my life and right now. I'm delighted some have thought that blog post worth sharing. This is what it said:
Paul Krugman drew my attention to a US report on comparing the quality and cost effectiveness of healthcare systems in seven major countries. The report he referred to was written in the context of the debate in the US on healthcare, but is just as applicable to the UK debate on the future of the NHS. Its summary is as follows:
1 is top rank, 7 lowest.
The UK ranks #2 overall. Hardly surprising since on 11 indicators it ranked in the top 3 on 8, and if quality and access are treated at their combined rather than disaggregated levels then it was in the top 3 on all indicators bar longevity of healthy life.
And all that for a much, much lower cost per head than the US market based system but also less too than everywhere but New Zealand, which ranks pretty poorly on everything but being patient focused.
So what does this say? I suggest that the longevity problem is not a health issue: this is a societal issue. It's the consequence of poor housing, inequality, poor health education, and many more such factors reflected in issues such as high obesity rates related to poor diet: a peculiarly British problem. The NHS cannot solve such problems. It's not reasonable to berate it for failing to do so.
That aside, care is great in the NHS. OK. it's not as patient focused as desired, but as the report says this is an issue where all countries could improve. No doubt that's true, but we trade something important here: price for patient focus. Of course people can be at the core of the NHS, but you seriously increase the cost if you double the time seeing the patient: most of NHS cost is labour. The choice is a straightforward one: you can have a patient focused NHS so long as you're willing to pay for it. If you are not willing to pay for it the patient focus will come at the cost of significantly reduced health outcomes. It's a trade-off that I think most would not make if they were given the choice. I think the NHS has got this right.
But most of all what this report says is that the room for efficiency gains in the NHS looks to be incredibly small. Patient centred activity has already been reduced to save cost. Timeliness has been compromised a little to secure savings. Efficiency is already rated as the highest in these seven countries. That's not surprising, the clear raw data shows that be the case. How, in that case, is the NHS going to deliver massive increases in efficiency in a system that is already operating at way above international standards?
We need to get real: the NHS is already delivering extraordinary value for money. Private sector alternatives are exceptionally expensive, as the US proves, with worse quality outcomes (as the table shows).
I am not saying that the NHS does not need improvement: of course it does. but to suggest that it needs a root and branch reform involving a fundamental restructuring because it is failing, as the Conservatives imply, is not just wrong, it's a straightforward lie.
The truth is that the NHS is actually a stunningly cost-effective supplier of high-quality healthcare, so let's celebrate the fact, and help those working in it to make it even better rather than going out of our way to destroy its structure, the morale of those who work in it, and to overburden them with impossible tasks which they can never fulfil that can only result in worse outcomes for us all.
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The stats for that blog are certainly impressive, Richard. But what a tragedy it is that in the two years that have passed since you wrote that blog the NHS as we knew it then has been ripped apart. We now have a system much closer to the US one – or it will be by 2015 – than most people appreciate. In fact, the NHS in name only. And the double tragedy is that I doubt that even if Labour are elected in 2015 they are able to reverse much of what has now been put in place – even if they had the wish to do so.
Still, looking on the bright side – if there is one to this sorry tale – at least the Tories and Lib Dems are going to have to live with the outcomes of their NHS policy through two more winters as the scale and scope of the disaster they have created becomes ever more visible.
We just have to hope people are aware by 2015
Never criticise the Conservative party for being ‘wrong’ in presenting the NHS as a failing and inefficient behemoth in need of reform.
The Conservative objective is to sell off lucrative opportunities for the extraction of rents to their generous friends in the private sector, and any excuse or PR drivel will do – no matter whether it is right, wrong, mendacious or mere distraction.
‘Here, have an excuse: we don’t care if you believe it and we’re doing this anyway. Now go away and argue about the excuses while we get down to business’.
Don’t focus on the excuses: the supply of excuses is infinite and your objections to the excuses do not matter. Attack the objective and never even acknowledge the excuses – not even to to dismiss them – unless you have an opportunity to bring the objective back into the centre stage.
…And watch out for passive resistance from the Parliamentary Labour Party. Or even crude attempts to hijack or suppress discussion altogether.
Hinchingbrooke and the disastrous Camden GP sell-off happened on their watch and it is not at all clear who profited from that, because it was then and is now transparenly clear that no ‘efficiency’ gain or public benefit would follow these decisions. And I look forward, with weary resignation, to reading pointless arguments over the familiar excuses – the very same ones used by the Conservatives – that serve no purpose other than to distract us from challenging the dishonest objectives of the policy. Even, or especially, among the argumentative and ineffective cohorts of the Labour Party.
The Labour Party will not be able to reverse this because of the international trade implications, and especially because of the US/EU Trade and Investment Partnership (TTIP) which is being negotiated at a fast pace with the aim of finalisation before elections here, in the US and in the EU.
The Labour Party is planning on pulling a reversal of the Health and Social Care Act, formulated to fit with the TTIP, out of the hat like a rabbit for the election here – but knowing that those liberalised contracts (i.e. with transnational firms) will be irreversible by then.
The Labour Party should be calling for a broad exemption of the NHS from this trade agreement NOW. They are looking for policies aren’t they? And they are paid to be the Opposition thorugh the term of the government – not just at election time.
For once, we are in agreement
“The Labour Party is planning on pulling a reversal of the Health and Social Care Act, formulated to fit with the TTIP, out of the hat like a rabbit for the election here — but knowing that those liberalised contracts (i.e. with transnational firms) will be irreversible by then.”
Nothing is irreversible! They just like us to think it is! It is simply amazing what can suddenly done when the political will is there.
Keeping open insolvent banks with hundreds of billions of pounds of public money being one obvious example.
The post war consensus was not irreversible, it was swept away by Thatcher without a second thought!
Believe me – if the political will is there, nothing, but nothing, is irreversable!
This is a very arse-upwards argument.
Yes nothing is irreversible – if the political will is there.
The ‘political will’ was certainly there to bail out banks, in fact the financial services industry dictate ‘the political will’.
But ‘the political will’ is certainly not there to go against trade agreements – that are primarily promoted by the financial services industry.
Its not big business that is trying to tell you that trade deals are irreversible. Business, politicians and the media don’t tell you anything about trade agreements. Trying to wake the public up to the implications is the hard part.
I believe in the principle of the NHS. And I don’t like much aspects of overt or creeping privatizations. But please let not descend to NHS under Labour “Good” under Coalition “Bad” because that simply is not true. There bigger forces at work e.g demographics and the activities of drug companies to name just two. I too have good connections with both the medical and admin sides of the NHS and some aspects are truly horrific. To name three, a) the medical profession is intensely protectionist, insisting on a rigid hierarchy, b) I can produce evidence of Consultants “slipping off” to do private work, and c) as for its Admin Purchasing operations are hopelessly inadequate leading to vast overspend.
I don’t think I am guilty of the crime
Labour was responsible for much of the start of marketisation
New Labour was nothing for anyone on the left to have been proud of