David Blackburn

The case for NHS reform

The case for NHS reform
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Britain remains the sick man of Europe. Professor Sir Mike Richards’s report finds that although progress has been made on cancer treatments, diagnosis rates, and therefore the chances of survival, lag behind European standards. A deluge of statistical analysis supports Richards's findings. The European Journal of Cancer’s recent research into solid cancers, such as breast cancer and melanoma, demonstrated that the speed of diagnosis and survival rates in the UK were “20% below” the European average. Additionally, the table below, which is taken from 2009’s OECD health data, illustrates that the gap between the number of cancer deaths per 100,000 population in Europe and the UK has widened.

  1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
UK 190 188.6 184.5   183.4 181.9 178.7 175.5 173.3 172 170.7
EU Average 185 183.1 182 180.7 169.1 166.4 165.5 156 152.5 153.1 142.1

A further problem is the shocking regional variation in performanance. 48% of lung cancer sufferers in Kensington and Chelsea survive; 85% of those diagnosed in Herefordshire die within a year. Both breast cancer survival rates in Torbay (99%) and Tower Hamlets (89%) and bowel cancer survival rates in Telford (80%) and Hastings (58%) indicate how divides between rich and poor and between the provinces and metropolises have not been redressed. This is not the legacy Brown and Blair intended.

What is to be done? UK health spending corresponds with other developed countries: this latest disappointment is not an excuse for government, present or future, to reach for our chequebooks. Plainly, record investments were spent unwisely. World class care is a target determined by outcomes, not an outcome determined by targets. The NHS labours under the weight of its own tremendous fabric; adopting mutualism over management will revolutionise NHS ownership and management, placing it in the hands of users and staff not bureaucrats, which should aid efficiency. 

By itself, structural reform provides an incomplete solution; re-emphasising the importance and expertise of personnel is equally important. Diagnosis relies on the awareness of doctors as much as it does on patients. That is not to explain the NHS’s failings solely by the incompetence of its physicians, quite the reverse. Despite employing nearly as many people as the Red Army, the NHS has one of the lowest counts of doctors per 1,000 head of population in the developed world: 2.48 to 4.03 in Belgium. Put simply, there are too few GPs referring to too few specialists.