Expert dismantles case for NHS reform
By Ian Dunt
The government’s case for NHS reform was dealt another debilitating blow today, after an expert dismantled the evidence used to justify it.
Health secretary Andrew Lansley and prime minister David Cameron both framed the need for NHS reform on the comparatively poor performance of the UK in cancer and heart attack cases.
But John Appleby, chief economist at the King’s Fund think-tank, challenged the claims, insisting that a comparison with European countries was highly problematic.
“Comparing just one year – and with a country with the lowest death rate for myocardial infarction (heart attack) in Europe – reveals only part of the story,” he wrote in the British Medical Journal (BMJ).
UK heart attack rates in 2006 were twice that of France but are set to be lower by 2012 if current trends continue.
“Not only has the UK had the largest fall in death rates from myocardial infarction between 1980 and 2006 of any European country, if trends over the past 30 years continue, it will have a lower death rate than France as soon as 2012,” he wrote.
“These trends have been achieved with a slower rate of growth in healthcare spending in the UK compared with France and at lower levels of spending every year for the past half century.”
Interpreting health outcome data was problematic because the “trajectory for many causes of death swoops up and down over decades – often linked to changes in lifestyle behaviours rather than spending on healthcare”.
He continued: “Our apparently poor comparison with other countries on cancer deaths has also been a key argument for reforming the NHS. However, comparisons are not straightforward and depend where you look.
“Death rates for lung cancer in men, for instance, rose steadily to a peak in the UK in 1979, but since then they have steadily fallen, mirroring long-term changes in smoking patterns, and are now lower than for French men, where the peak death rate occurred over a decade later in the 1990s.”
The argument removes another plank from the government’s defence of its NHS reforms, which have been roundly condemned by medical experts, unions, Commons committees and opposition parties.
“I don’t think there is an option of just quietly standing still, staying where we are and putting a bit more money into the NHS,” Mr Cameron told the Today programme earlier this month.
“Every year we delay is another year our health outcomes lag behind the rest of Europe.”
Shadow health secretary John Healey responded: “David Cameron seems to see the NHS as second rate when everybody else has seen big improvements by Labour in recent years and public satisfaction is now at an all-time high. This is an insult to millions of NHS staff.”
