It’s a commonplace that the National Health service is a Wonder of the World. Such a phantastic creation that near no one other than Cuba has bothered to try to replicate the structure. It’s also a commonplace that the NHS is one of the best rated health care systems in the world. By those who measure “best” on such things as equity of financing, equity of treatment. The NHS is also one of the world’s worst rich country health care systems by an entirely reasonable measure of how well it actually works. Mortality amenable to health care treatment is the measure by which the NHS regularly props up the bottom of the league table.
So, a reasonable description of the National Heath Services is fair but faecal.
A useful little measure of which is this:
[perfectpullquote align=”full” bordertop=”false” cite=”” link=”” color=”” class=”” size=””] Almost two in three trusts are missing NHS cancer targets, amid warnings that patients are being put at risk as waiting times grow longer. MPs said patients were facing “unacceptable” and “agonising” delays, with more than half of trusts also forcing patients into long waits for surgery. The report by the Public Accounts Committee accuses health bodies of “a lack of curiosity” about the risks that patients would come to harm as result of increasingly long waiting times. [/perfectpullquote]Not particularly that the targets are being missed. Rather, the paucity of the targets themselves:
[perfectpullquote align=”full” bordertop=”false” cite=”” link=”” color=”” class=”” size=””] The report, published on Wednesday, warns that a key target for cancer patients to receive treatment within two months has not been hit since 2013. Last November, just 38 per cent of trusts achieved the standard. Meanwhile, 44 per cent of trusts hit targets to carry out planned surgery within 18 weeks. [/perfectpullquote]60 days for cancer treatment? Whut?
Fortunately we do in fact have good internationally comparable statistics on one cancer, breast cancer. It happens a lot and treatments around the world are generally the same. Thus we can compare. The median time to treatment in the NHS is 22 days. Median in California is 8, in Canada 11. Oh, and:
[perfectpullquote align=”full” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Survival from breast cancer in the United Kingdom is lower than in other developed countries.[/perfectpullquote]See, the NHS is bad at actually curing us of what ails us. Which isn’t, when you come to think of it, a recommendation of a health care system, is it?
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See, the NHS is bad at actually curing us of what ails us. Which isn’t, when you come to think of it, a recommendation of a health care system, is it?
Ah, but you need to take the COST into account.
I suspect that you could achieve impressive survival rates by having a single doctor allocated full-time to each patient. Conversely, you could run a very cheap service with one doctor per county. The question is, where is the balance to be placed?
I believe that the NHS operates a mathematical decision process for determining how treatment should be allocated, balancing cost against outcome. If we are trying to compare like with like, we should really look at this technique, determine if the service is optimal according to it, examine the cost-benefit techniques used by other countries and make a political decision about where we want the balance to be placed.
Would we, for instance, be prepared to pay another 2.5% National Insurance in order to improve cancer survivability by an extra 120 people per year? Would we prefer to cut NI by 6% and have 3280 extra deaths? These are difficult and complex questions, and they are not answered by comparing clinical outcomes in other countries with completely different financial provisions...
It is not all about spending. France, Italy, Malta, Singapore, Spain, Austria, Japan, Norway, Portugal, Monaco, Greece, Iceland, Luxembourg and the Netherlands, to name but a few, all have better outcomes than the UK across the board, a number spend considerably less, some a fair bit more, on health care than the UK does.
The NHS is particularly bad at saving lives once treatment has commenced, meaning it offers poorer treatment than many other countries, even though it is spending in many cases more on that treatment.
The acid test is whether or not the cost of the NHS, roughly 2k per person, would provide better outcomes if that 2k were spent from cradle to grave on private health insurance. Unfortunately we can't run such a test, equally unfortunately the NHS is failing both relatively and substantially to provide good quality of treatment, spending more might be part of the solution, but it certainly isn't the whole picture.
It is not all about spending. France, Italy, Malta, Singapore, Spain, Austria, Japan, Norway, Portugal, Monaco, Greece, Iceland, Luxembourg and the Netherlands, to name but a few, all have better outcomes than the UK across the board,
By 'cost' I mean cost allocations. If one country decides to have different priorities to another, it will spend differently, and of course the outcomes for different diseases will differ. It is not even all about outcomes. You need to compare like with like - As Mr Worstall did with breast cancer. And all these countries have different base rates of illness.
The NHS performs many functions. Its emergency services, for instance, are generally considered to be among the world's best. So you might need to take that element out of the figures before making any comparison on other clinical services. In fact, you will find it remarkably difficult to make any kind of meaningful comparison - you would need to find a country of similar size with similar health characteristics and similar priorities before making any statistical comparison...
A visit to casualty might disabuse anyone that the UK's emergency response is anything but terrible. Live outside an urban area and the service, or more accurately its tardiness, is seriously concerning.
And really it is all about outcomes, do you get better or not. With the NHS you are less likely to than in many a country.
It's not just cancer though. The NHS's outcomes (mortality amenable to health care) are poor across the board, relative to other European countries, some of which are poorer than the UK.
I think it's a fair point that emergency services are generally good in the NHS. But urgent care is more mixed. So great services for people who've had serious accidents, been stabbed or suffered a heart attack. Less good for more minor issues. That's probably an ok trade off.
But access to primary care is terrible. And hospital performance is falling badly, not because of insufficient money, but because there aren't enough clinical staff (a consequence of central planning). The rubbish IT, which could help tackle that by improving low productivity, doesn't help either - again, largely a consequence of government provision.
So, on any reasonable comparison: the NHS performs relatively poorly compared to other European countries. It is relatively cheap, but probably at the long term cost of insufficient investment in IT and people.