Don't write off the NHS
The service's reputation has been hurt this week, but that's no reason to abandon Bevan's baby
The NHS is the envy of the world, we're told, but we have a better chance of dying of cancer than our neighbours in France, Germany, Sweden, Iceland or even Poland, and if you are at high risk for stroke you might like to think about emigrating. Two reports this week, and they were not the flimsy scaremongering variety but from medical heavyweights, will have given the Department of Health a collective headache and made the rest of us justifiably twitchy.
It's a bad week for those who like to cuddle up to the notion that the state will sort us out if we are sick, but its too early to write off Bevan's baby as a creature that never grew up. It might be different if the reasons for poor performance in cancer and stroke care were the same, but they are not.
Cancer is an emotive issue and the greater fuss will probably be made over our latest poor showing in the Eurocare studies. These chronicle the level of five-year survival - the proportion of people living after diagnosis for at least five years - for different types of cancer. The latest measures survival for those diagnosed between 1995 and 1999 and follows them to 2003, while a second study estimates survival for those diagnosed between 2000 and 2002 and compares Europe's performance with the US's.
And of course Europe trails the US, and the UK trails most of affluent Europe. And that's after big funding increases attached to the national cancer plan for England in 2000. It's not good. It's all very well to argue that the bells and whistles of the cancer plan were not in place when these patients were diagnosed. They were still treated during the early years of the plan. Many would agree with the editorial in the Lancet Oncology, which published the study, that the answer to the question has the cancer plan worked is "seemingly no".
But cancer tsar Mike Richards's careful response also has truth in it. First, our data collection is better than that of most countries. But second, we have a social problem to tackle that is rooted in the inequalities that underlie so much in the UK. Poor people and many ethnic minorities do not go to the GP at the first symptom that could be cancer. Many people leave it too late.
Then there is stroke care. Professor Hugh Markus from St George's, University of London, painted a grim picture, citing three major studies to show UK patients were more likely to die or become disabled by stroke than in comparable European countries. Is money at the root of it? Well, no. We spend as much as other countries. But we spend it in the wrong way. We're focused on caring for people who have had a stroke, when what is needed is action when the stroke occurs. Key to a good outcome are clot-busting drugs, which can be administered in the ambulance. They caught on a lot faster elsewhere. In the past in the UK, he told Channel 4 News, people, by which he meant doctors, thought stroke was boring.
What these barrages of criticism tell us about the NHS is that it is not brilliant across the board. Must try harder. But two poor grades in two distinct subjects don't make for a failed health service. The NHS deals with a vast range of conditions and has a lot of very happy customers. Time and again, as the government loves to tell us, patient surveys reveal that we love and admire our doctors and value the care we get.
And only a few weeks back, we had a study that came up with a very different conclusion. The Commonwealth Fund in the US compared healthcare in the UK, Germany, the US, Australia, New Zealand and Canada across a range of measures. Who came last? The biggest spender, the US. Who came first? The UK. And the main reason was that everybody has free access to good care. It's time to work on the NHS, not write it off.
Sarah Boseley
Saturday August 25, 2007
Guardian Unlimited
© Guardian News and Media Limited 2007
The service's reputation has been hurt this week, but that's no reason to abandon Bevan's baby
The NHS is the envy of the world, we're told, but we have a better chance of dying of cancer than our neighbours in France, Germany, Sweden, Iceland or even Poland, and if you are at high risk for stroke you might like to think about emigrating. Two reports this week, and they were not the flimsy scaremongering variety but from medical heavyweights, will have given the Department of Health a collective headache and made the rest of us justifiably twitchy.
It's a bad week for those who like to cuddle up to the notion that the state will sort us out if we are sick, but its too early to write off Bevan's baby as a creature that never grew up. It might be different if the reasons for poor performance in cancer and stroke care were the same, but they are not.
Cancer is an emotive issue and the greater fuss will probably be made over our latest poor showing in the Eurocare studies. These chronicle the level of five-year survival - the proportion of people living after diagnosis for at least five years - for different types of cancer. The latest measures survival for those diagnosed between 1995 and 1999 and follows them to 2003, while a second study estimates survival for those diagnosed between 2000 and 2002 and compares Europe's performance with the US's.
And of course Europe trails the US, and the UK trails most of affluent Europe. And that's after big funding increases attached to the national cancer plan for England in 2000. It's not good. It's all very well to argue that the bells and whistles of the cancer plan were not in place when these patients were diagnosed. They were still treated during the early years of the plan. Many would agree with the editorial in the Lancet Oncology, which published the study, that the answer to the question has the cancer plan worked is "seemingly no".
But cancer tsar Mike Richards's careful response also has truth in it. First, our data collection is better than that of most countries. But second, we have a social problem to tackle that is rooted in the inequalities that underlie so much in the UK. Poor people and many ethnic minorities do not go to the GP at the first symptom that could be cancer. Many people leave it too late.
Then there is stroke care. Professor Hugh Markus from St George's, University of London, painted a grim picture, citing three major studies to show UK patients were more likely to die or become disabled by stroke than in comparable European countries. Is money at the root of it? Well, no. We spend as much as other countries. But we spend it in the wrong way. We're focused on caring for people who have had a stroke, when what is needed is action when the stroke occurs. Key to a good outcome are clot-busting drugs, which can be administered in the ambulance. They caught on a lot faster elsewhere. In the past in the UK, he told Channel 4 News, people, by which he meant doctors, thought stroke was boring.
What these barrages of criticism tell us about the NHS is that it is not brilliant across the board. Must try harder. But two poor grades in two distinct subjects don't make for a failed health service. The NHS deals with a vast range of conditions and has a lot of very happy customers. Time and again, as the government loves to tell us, patient surveys reveal that we love and admire our doctors and value the care we get.
And only a few weeks back, we had a study that came up with a very different conclusion. The Commonwealth Fund in the US compared healthcare in the UK, Germany, the US, Australia, New Zealand and Canada across a range of measures. Who came last? The biggest spender, the US. Who came first? The UK. And the main reason was that everybody has free access to good care. It's time to work on the NHS, not write it off.
Sarah Boseley
Saturday August 25, 2007
Guardian Unlimited
© Guardian News and Media Limited 2007
