NHS: time to disestablish our ‘national religion’?
If England’s hospitals are as bad as Channel 4 News suggests, why is discussion of NHS reform still political kryptonite?
On Channel 4 News last night, the main story centred on apparently shocking figures about death rates in NHS hospitals. The figures were indeed shocking – but only in the sense that they seemed shockingly shoddy.
‘Cradle-to-grave care: it’s what the National Health Service was set up to do’, said presenter Cathy Newman, ‘but shocking new figures given to this programme reveal that the NHS is fundamentally failing. They suggest that death rates in hospitals in England have been far higher than in hospitals in other countries.’ The stats were put together by Professor Sir Brian Jarman; they indicate that in 2004, death rates in English hospitals were the highest among seven developed countries. The adjusted death rate for English hospitals was 22 per cent higher than the average for the countries studied and 58 per cent higher than the best-performing country, the US.
Comparing UK and US figures must be fraught with difficulties. For starters, many people in the US are without medical insurance. Some are covered by state provision, but many are not, which was the impulse for President Obama’s healthcare reforms. So it may be that poorer people, with a tendency to worse health, never make it to hospitals in the first place.
What is certainly true is that the US spends far more on healthcare than the UK. Even government-funded healthcare in the US costs more than the UK, despite only covering a minority of the population. According to a statistical note for the House of Commons in 2011, the US government spends the equivalent of 7.4 per cent of GDP to provide healthcare to 46.5 per cent of its population. The UK government spends 7.2 per cent of GDP to cover 82.6 per cent of its population. In total, including private expenditure, the US spends 16 per cent of GDP on healthcare compared with 8.7 per cent in the UK.
So it should not be surprising that the US performs better than the UK. Channel 4 News took us to the Mayo Clinic in Phoenix, which, as reporter Victoria Macdonald noted, looked more like a grand modern hotel than a hospital. It would be a shock if such institutions didn’t manage to perform better than the average district general hospital in the UK.
It wasn’t only cost comparisons that were missing – so were basic statistics. Viewers were not offered a comparison of absolute death rates, just relative ones. Would you be prepared to pay higher taxes to improve death rates from, for example, 98.5 per cent to 99 per cent? We didn’t get the figures in the report to make such a judgement. Macdonald even suggested that at the Mayo Clinic a patient would be ‘twice as likely to survive as a similar patient with a similar condition in the average NHS hospital’. That would suggest that over half of in-patients in English hospitals don’t come out alive. Presumably, she meant that death rates at the Mayo Clinic were half those of an average NHS hospital. Let’s hope so, or we really do have a scandal on our hands.
In all of this, the one discussion that is always out of bounds is the question of whether the current model of tax-funded, free at the point of delivery healthcare in the UK is the best one. Apart from funding, maybe another factor in the US is that those who use hospitals are paying customers as well as patients, so hospitals have to try a bit harder to listen to their concerns and provide appropriate care.
But as Macdonald noted, the NHS is the nearest thing we have to a ‘national religion’ these days and the most socially acceptable face of government-knows-best thinking. Instead of constantly treating such problems as minor ailments on an otherwise health body, maybe it is time for a proper and hard-headed diagnosis of the NHS’s ailments with all treatment options on the table. It may well be that a tax-funded system is the best way forward, that for all its faults it still provides the widest care at the lowest price. But we’ll never know because, by and large, politicians refuse to discuss it.
Rob Lyons is associate editor at spiked.