This week, I have been in Washington talking to leaders of health systems around the world about the challenges we face and about how we in this country are going to deal with them.
While the week’s focus has been on the continuing fallout of the financial crisis and the long-term problems of sovereign debt, in healthcare the world faces similarly shared challenges: not just the immediate challenges of fiscal restraint, but also the longer-term challenges of an ageing population and of the rising costs of treatments and technologies.
We are in the relatively unique position of having protected spending on the NHS. But across the world, all countries are now coming to terms with the longer-term pressures that will be placed upon them. Because although healthcare is not the most pressing of challenges facing the world right now, without health we have nothing.
For too long, there has been a false trade-off in healthcare systems between equitable access and excellent treatment. This is fed by the misplaced belief on the one hand that the very best healthcare available anywhere in the world can only be provided through a fully-privatised system which strives to deliver the best for the richest but which excludes the poorest. And, on the other hand, by the equally misplaced belief that the most equal systems can only be delivered by a system in which everything is planned, organised, funded and run by the state without reference to the treatment that patients may want or choose.
These false beliefs have led policymakers, over decades, in countries across the world, to truly bizarre conclusions. In equitable healthcare systems, the notion that patients may want choice or that new healthcare providers may have something to offer has typically been met by cries of privatisation, of postcode lotteries and of profiteering. And in fully-privatised systems, any hint of developing a more equitable approach is met by commentators howling against the injustice of "socialised medicine" denying patients the choice and control which they want.
Across the world we have to tackle these myths, because fully-privatised systems will be crippled by the burdens of failing to care for the uninsured, and systems run on a command-and-control basis, from the top down, will collapse under the burdens of public expectation. The truth is that there is nothing incompatible between equitable access and excellent healthcare. Furthermore, the fact that everyone has universal access to healthcare here in the UK itself lays the foundations for the excellence we want to see. There is no excluded group, no medical condition left uninsured, and no area of the country left to go without – meaning that every patient, everywhere, wants the NHS to deliver the best possible care that it can.
In the UK, we are lucky to have an NHS which delivers healthcare free at the point of use, based on need and not ability to pay. We are luckier still that the vast majority of those working in healthcare do so as dedicated public servants – working not just for the money that they earn but for the sense of pride and duty in helping everyone get the care they need. That is why we in the Conservative Party reject the privatisation of the NHS – either in how it is funded or in the ownership of its assets.
But the enduring commitment that we have to those values should not dissuade us from reforming a system long characterised by excessive bureaucracy, lack of patient power – and sometimes poor results for patients. And we can learn from those other systems around the world which do, at their best, deliver the best results. Systems which put patients in control of their own care, giving them the power to choose how, where and by who they are treated. Systems which put doctors and other healthcare professionals in the driving seat. And systems which are open and transparent about the results they are achieving.
Equity and excellence are not incompatible objectives. They are mutually reinforcing. We in this country have the luxury of an equitable system to which all political parties are committed. We must now give patients and doctors and nurses the power and the tools to build excellence for all upon those firm foundations.