Reclaim Some Pride
I’m sick of reading negative news stories about the NHS.
Of course there are legitimate concerns, and I want to hear about those: The events at West Staffordshire Hospital and the damning response of the Francis Report. The crisis at the Bristol Heart Unit, and the debate over closure. The 17 trusts under investigation in the wake of the Keogh Report. Currently, the A+E crisis dominates the news — is it real? And if so, why are we closing A+Es to fix it? All of these stories spark debate and research in the medical community and have overall positive benefit. I welcome public interest into a public institution (just not quite the level of political interference we get at the moment — but that’s for another time!)
However these stories also generate a pervasive negativity towards the NHS, fanned into flame by the media, and accepted widely from discouraged NHS staff to disgruntled NHS patients. We are told that nothing is right, that everything is an outrage. As patients we expect to get everything we want, and remember only the failures. We take this anger with us and unfairly aim it at the workers of the NHS the next time we don’t get what we expected or wanted. As a Doctor, this is discouraging to say the least.
In light of this, I feel it is important to remember the good stories. The ones that are positive. The ones that bring hope. The ones that happen every day and go untold and unnoticed. Like my grandma who refused for ages to go to the GP despite severe depression, but once encouraged bonded with the Locum GP, accepted tablet therapy, and is much happier as a result.
Professor Don Berwick was asked by the Department of Health to consider, in the wake of the Francis and Keigh Reports, how best to move the NHS forward, said this is his open letter to NHS managers —
“You are stewards of a globally important treasure: the NHS. In its form and mission, guided by the unwavering charter of universal care, accessible to all, and free at the point of service, the NHS is a unique example for all to learn from and emulate. Faults are to be expected in any enterprise of such size and ambition, and, as you know, the nation’s leaders have the dual duty to continually, unblinkingly recognize and reduce those fault and at the same time to maintain and build confidence in the grand vision of the NHS.”
Therefore when a story as big as this comes along we need to shout it from the rooftops. It is therefore with great excitement that I report the results of the 2014 update to the Commonwealth Fund report comparing different healthcare systems globally — Mirror Mirror. And I do this in order to encourage you, the British Reader, to have faith in Your NHS, and to work with it as it continues to improve.
Background — The Commonwealth Fund are a private American Foundation set up in 1918 dedicated to the common good. Now, it’s mission statement is to promote high quality and fair provision of healthcare, with special regard to the disadvantaged. In America, they commission independent research and make grants from assets worth near to $700 million. They generally dont accept donations, making them freer than most from industrial or political Bias. In the past they have funded Dr Gerogios Papanikolaou’s work in developing the eponmyous ‘Pap Smear’ in the 1940s— now the standard diagnostic test for cervical cancer. They also funded Dickinson W Richards in his work on cardiac catheterization, earning him a Nobel Prize in 1956. Now they advise on Health Policy, working with Medicare and Medicaid, fund fellowships for research, were heavily involved in the implementation of Obama’s Affordable Care Act, and host an international conference of healthcare policy.
The 2010 update of Mirror Mirror ranked the UK second on its list, right after Netherlands. This year, the UK came first. The countries studied were Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK and the USA.
In 2000, the WHO Ranking placed UK 26th out of 191. It was widely discredited in academic circles for its lack of robustness, nonetheless this statistic has long been used against the NHS by those seeking an easy put-down. It is good to see our standings increase in this ranking, especially since the usual suspects when it comes to making a comparison, France (1), Norway (11) and the Netherlands (17), were all previously ranked above us by the WHO.
Mirror Mirror is a report started in 2004 which mixes objective data on health outcomes for each nation studied (from the WHO and the OECD — the Organisation for Economic Cooperation and Development), with subjective survey data from both the general public and from physicians, about care experiences. International information on health outcomes (objective, and comparable) is scarce, but surveys of both patients and physicians cross-nationally are funded by the Commonwealth Fund, using a core set of questions to cut across national differences. As much as possible, this study uses concrete facts, but whilst opinion is less quantitative, it still remains a valid scientific tool. Furthermore, it is with a view to wholly patient-centric care that we must think to improve any healthcare system, so who’s opinion could matter more than those of the patients?!
From these surveys, this report gathers information on 80 indicators, organised, into five dimensions, as you can see above— Quality of care, Access to care, Efficiency, Equity and Healthy Lives. Countries are ranked for each indicator and then dimension rankings averaged to find the overall rank. Quality of care is divided into four measures — effective care, safe care, coordinated care and patient-centered care. Access to care is divided into cost-related access and timeliness of the care.
The UK came first in Quality Care, topping the chart for all four measures. The UK came first in Access to Care, in both its measures. The UK was the most Efficient system. It came second in Equity of Care and was only let down in the Healthy Lives category, coming 10th. All of this was compared to Health Expenditure per capita in 2011 (which incidentally is lowest for the UK). Ahem. According to OECD figures, the UK spent 9.4% of its GDP on Healthcare in 2011 (7.8% Public, 1.6% Private) — less than any other country in this survey. What is more, it did it using the greatest porportion of public funding (meaning the cost was not born by the individual) with the least actual public spending. Despite the fact that the USA funds the majority of its healthcare system via private insurance, its government still spends more per capita on health than ours does in providing our ENTIRE healthsystem.
These are grossly over-simplified figures, and we can’t ever hope to successfully model the differences between healthcare systems, but I believe that this information shows a number of things:
- that despite media-incited fears to the contrary — we are getting quality care from the NHS
- that despite our difficulties — we are getting access to that care quickly and cheaply
- that despite our concerns NHS is already very efficient
- that despite what the media may tell you the NHS IS affordable from the public purse — we aren’t paying too much and we aren’t being conned
- That the US system, held up as the model Free Market system, doesn’t compare favourably to our Nationalised Institution.
- that despite these triumphs, British people are NOT the healthiest in the comparison, and that we must look to other reasons that our healthcare provision to explain this (eg Diet, Exercise, Stress, Genetics).
This is not Britain’s Got Talent, neither is it ‘Strictly Come Healthcaring’. It is not about coming first in a competition, and beating the other nation rivals. As ever, the real value is in knowing that the patient is getting the best they can. By encorporating survey data on how people feel their healthcare system is doing, I believe this survey shows just that. It’s important to remember that, although we are unhappy, the Spaniards and French are just as worried about their healthcare provision as us, and in this survey more so!
So what does this all mean? It doesn’t help us improve our service. It doesnt reduce waiting times, and it doesnt improve cancer outcomes. However, as Professor Berwick noticed, we all need to have a bit of pride to work together in our NHS because a pervasive negative culture will lead to tragedy, as has already been identified at West Staffordshire.
A bit of national pride is not something that British people are familiar or comfortable with, so with all the bad press the NHS gets, I felt it was right to shout this one from the rooftops. NHS number one!
