Shane Frith is director of the classical-liberal think-tank
Progressive Vision. He has worked for Conservative MPs in the UK and
National Party MPs in his native New Zealand. He is a former chairman
of the International Young Democrat Union, linking young people
involved in centre-right political parties worldwide, including the
Dan Hannan – and now Charles Tannock – have done Britain a great service by sparking the first serious debate I have seen about the NHS. While Dan is in a minority, the issues he raises deserve serious discussion, not least because more that 17,000 Britons die in the NHS every year that would not have if they were treated in the US, France, Germany or Singapore.
This 17,000 isn’t the number of people die in hospitals, that number is vastly larger as it is anywhere in the world – by their nature hospitals contain the dying. The 17,000 figure is arrived at by comparing five year survival rates between countries. On these measures the NHS rates extremely poorly in international comparisons. Britain has one of the worst five-year cancer survival rates in the OECD and certainly well behind the best, the United States. England has a female cancer survival rate of only 52.7%, compared with 62.9% for the United States or 61.8% for Iceland.
I have yet to find a better metric for comparison of health systems as opposed to health of a nation. Life expectancy is a poor measure as it doesn’t take into account people who die from violent crime and road accidents. If you take these factors into account, the US has a higher life expectancy than Britain. However, even this fails to account for rates of smoking, alcohol abuse or obesity. Likewise, infant mortality is flawed when comparing the US as they measure “life” differently. A newborn baby that dies seconds after birth is often recoded as stillborn in Europe, but not in the US – resulting in higher infant mortality statistics.
Other international comparisons use subjective measurements of “access” and “equality”. There is certainly objective evidence that the US system is unequal, but this same measure shows that, with one exception, the poorest group of Americans (if you take "black" as a proxy for poor) has better health outcomes than the average Briton.
So, can we get over this myth that the NHS is the envy of the world? It is clearly not – otherwise it would have been widely copied. Despite the claims of some, even Barack Obama isn’t proposing a system where the state would own hospitals and pay for the healthcare of 90% of the nation.
Arguing that the NHS is a poor health system is not arguing that Britain should have no health system. Nor should it be interpreted as a defence of the US system. I, like Dan Hannan, prefer the Singapore system of health savings accounts (read Dan and Douglas Carswell’s excellent book, The Plan). Such a system provides better health outcomes than the UK whilst keeping expenditure at 3.8% of GDP. If Britain could achieve these efficiencies, this would save £60 billion a year.
I am astounded at the revere in which the NHS is held and recently realised that those most critical of the NHS have experienced healthcare abroad. The penny finally dropped earlier this month when a friend said I was being too harsh on the NHS as it had recently given him excellent treatment. I listen to his wonderful story of how he was treated for free and was now fully recovered. Frustrated, as I’ve just been denied an NHS appointment for any sooner than ten weeks for a knee injury, I asked how long it took him to receive treatment – ten weeks. Astoundingly, his “great service” involved a ten week wait for treatment! Waiting ten weeks for important medical treatment doesn't constitute adequate service, let alone great service.
Moreover, if my friend had actually received the great service he thought he had, this wouldn’t be proof of the NHS’s greatness. Saying that the NHS is great because it saved the life of your great aunt isn’t any more proof than claiming that the US or Singaporean systems are great because they save lives every day. It is the job of health systems to save lives and even the worst ones do so on a regular basis.
I realise now that many Britons are now like Moscovites in 1985: they thought queuing for bread was normal. This changed with Glasnost and they started to learn what existed on the other side of the Iron Curtain. While the Soviet Union never had the freedom of speech enjoyed in the UK, we do suffer from a political climate that treats criticism of the NHS as akin to Holocaust denial. Belief that the NHS is the “envy of the world” or “one of the greatest inventions of the 20th Century” borders on a national self delusion. Political leaders must be aware of this and their unwillingness to discuss alternatives is cowardly and is doing the nation a great disservice.
On objective measures of outcomes, the NHS is one of the worst systems in the developed world and far from the best. A truly progressive politician would seek to provide Britain with the best health system in the world. It is not progressive to accept a system that allows more that 17,000 vulnerable people to die needlessly in Britain each year. It is time to sensibly consider alternatives, not ridicule those who propose a way to save more lives.