Postponing our appointment
"The UK has had universal free health care and public health programmes for more than six decades. Several policy initiatives and structural reforms of the health system have been undertaken. Health expenditure has increased substantially since 1990, albeit from relatively low levels compared with other countries.... However, the UK performed significantly worse than the EU15+ for age-standardised death rates, age-standardised YLL rates*, and life expectancy in 1990, and its relative position had worsened by 2010."Today's report in the Lancet is a timely companion to yesterday's blog. Not that it tells regular BOM readers anything particularly new about the under-performance of our nationalised healthcare system, but the facts need to be known much more widely, and this Lancet study has certainly grabbed the headlines.
The study focuses on premature death, and as we've blogged many times, compared to its counterparts just across the Channel, the NHS is pretty poor at keeping us alive. In the BOM book we summarise the key figures on premature death, including our low survival rates for cancer and heart disease. In fact, every year around 50,000 of us - the population of Salisbury - die from diseases which should in theory have been treatable (so called Mortality Amenable to Healthcare). Of course, no healthcare system manages to prevent all such deaths, but the European social insurance systems do much better.
And although our life expectancy has increased hugely under the NHS, nobody can seriously argue that's down to the NHS itself. While life expectancy has increased by around 13 years since the NHS was founded, in the previous five decades it had increased by 20 years. These are worldwide trends, and they reflect improvements in medical knowledge and diet much more than the efforts of our underperforming NHS.
However, despite the headlines, the Lancet article did not set out to be an NHS hatchet job. Rather, it puts the blame for our poor showing on our own unhealthy lifestyles - too many horse burgers and not enough press ups. And the report's authors clearly want more state intervention to control our unhealthy lifestyles. More public health programmes, more booze taxes, more fat taxes, more sugar taxes, more indolence taxes, etc etc.
You can certainly see how you get there - if we could all be hassled or forced into living healthier lives, we'd almost certainly live longer and probably save the NHS a shed-load of cash. It's exactly the kind of thinking that drove Labour's anti-obesity programme, although somehow they never did get round to fat and sugar taxes.
Except of course, that's not how the better performing countries do it. Although France, Spain, and Italy all outperform us in this study, my own extensive research suggests that their booze taxes, at least, are an awful lot lower than ours. The issue is rather more complex than comparative tax rates and public education campaigns.
What this study really highlights is that when it comes to health, we have a lot to learn from our neighbours. None of them have a nationalised health system, yet most of them enjoy longer healthier lives than us. Instead of pretending our healthcare system is the envy of the world, we should have the humility to look and learn.
PS I've just been listening to Sir David Nicholson being grilled by the Health Select Committee. I must say I admire the guy's sheer nerve. Yes, he says, terrible things happened at mid-Staffs while I was in charge of the regional health authority, but I knew nothing about it. Barclays tried that one, but Diamond still had to walk the plank. And even if Nicholson didn't know, he surely should have done. As we've said many times on BOM, you can delegate authority, but you can never delegate responsibility.
*YLL is Years of potential Life Lost