Sunday, 23 March 2014

A Comparison of Healthcare in UK, US and France


At a time when NHS funding is being squeezed and both GP (primary care) and hospital services are coming under huge pressure, it is worth looking at a comparison of healthcare systems in the UK, US and France.
While France enjoys a slightly longer life expectancy than the UK, it spends 12.5% of its GDP on healthcare (£3000 per head) compared to 9.4% (£2190 per head) in the UK. France has 6.4 hospital beds per 1000 of the population (of which 65% are privately funded) compared to 3 beds per 1000 in the UK (where only 15% of beds are privately funded). 49% of French doctors are GPs compared to 30% of UK doctors.

In stark comparison, the US (whose healthcare system we risk emulating) has the shortest life expectancy despite spending 17.2% of its GDP on healthcare. Only 12.3% of US doctors are GPs.

A solution to the current NHS crisis will require many approaches. Ongoing disruption of the world's most cost efficient health service increases healthcare costs. Administrative costs now account for 30% of NHS spending. Some of that spending needs to be clawed back and spent on the frontline. An urgent priority now is to support and strengthen GPs who form the backbone of the NHS.

Source: OECD

Tuesday, 11 March 2014

Reshaping the NHS: talk by Sir Ian Kennedy, Annual BFSA Lecture

Sir Ian Kennedy QC spoke on 'Reshaping the NHS' at yesterday's annual general meeting of the British Fulbright Scholar's Association, held at the very impressive Two Temple Place.

Sir Ian is the Emeritus Professor of Health Law, Ethics and Policy at UCL, an Honorary Fellow of the Royal College of Physicians, and Vice Chair of the College of Medicine. He previously chaired the public inquiry into paediatric cardiac surgery at the Bristol Royal Infirmary, and was chair of the Healthcare Commission from 2003 to 2009 (before it became the CQC).

Eminent Fulbrighters in the audience included Prof John Lazarus and the amazing Katharine Whitehorn.
Sir Ian spoke of the differences between changes in NHS structure and culture. He described the NHS as 'a moral enterprise, short on reflection and enterprise'. Ultimately our devotion to the NHS boiled down to two things: Do we love our neighbour? And how much?

Had the NHS run its course? Of course not, he said. But he did raise two questions, both difficult to answer: Where should the money come from? What should we spend it on?

He drew from his vast experience of public inquiry into healthcare disasters to describe anecdotes of appalling behaviour by healthcare professionals, often a result of system failures. Sadly for me, he did not highlight the many wonderful achievements of the NHS, most importantly the delivery of universal and comprehensive healthcare, free at the point of delivery (1).

When asked what the NHS could be proud of, he hesitated. He might have quoted Prof Don Berwick, Harvard Prof turned UK Health Tsar, who on the NHS' 60th birthday described it as 'one of the astounding human endeavours of modern times' (2). For my summary on Don Berwick and the NHS, see here.

There was much in Sir Ian's lecture that I found useful. He emphasised the importance of Service in the NHS, and talked about developing 'a culture of service'. The key to this, he emphasised, was STRONG LEADERSHIP. How do we persuade NHS leaders to stay in post for longer (the average lifespan of an NHS CEO is 2 years)?

We need leaders in all sectors of the NHS, leaders amongst the cleaners, the porters, and so on, as well as doctors and nurses. How do we identify and develop these leaders? He spoke of  the three hallmarks of good leadership: having a vision, communicating that vision, and living the vision. For a short video on how NHS leadership at my own NHS trust is winning national awards, see here.

Sir Ian talked about putting the patient at the centre of everything. VERY IMPORTANT. Employee engagement, he also said, is the best indicator of quality of service. 

Sir Ian's talk was informative, entertaining, well received and provoked vigorous debate. The Commonwealth Fund data (3) was discussed briefly. During the Q and A, I spoke of my own experience of how the NHS has rapidly adopted new approaches to emergency heart attack treatment (4). 

I think it's fair to say that by the end of the evening in that wonderful venue, we all learnt something new about how the NHS can and will improve further.


Vinod Achan

Vinod Achan is a Consultant Cardiologist and the Clinical Lead for Primary Angioplasty at the Surrey Heart, Stroke and Vascular Centre, Frimley Park Hospital NHS Foundation Trust. Frimley Park Hospital NHS Foundation Trust is an award winning 24/7 regional Heart Attack Centre, performing over 1000 coronary angioplasties a year and delivering emergency cardiac care to a population of one million people.