A sensible discussion on healthcare policy requires brutal honesty on outcomes
As a team of doctors entered the ward, pulling the thin curtain around her bedside to offer a slither of privacy, her family fell silent. Shortly afterwards came the heartbreaking sound of uncontrollable grief. Cancer had spread to her spine, and Anita was told she had just a few months to live. A mixture of outright anger and powerless agony gripped her family. At that moment, one realised how behind every statistic about health outcomes and misdiagnosis, comes a harrowing human story.
Look carefully, and one finds similar tales in national and local newspapers each week. When one witnesses first hand something like this, it’s difficult to accept the ‘plural of anecdote is not data’ saying. Yet a cold, hard look at the effectiveness of our health system requires just that. The NHS should not be judged by the worst cases, but then neither should anecdote about ‘the NHS saving my grandad’ or ‘my baby was delivered by the NHS’ blind us from expecting our health system to deliver high standards overall for both care and treatment. We should not accept the implied poverty of ambition that comes from comparing outcomes now to when the NHS was founded, or against a counterfactual of no healthcare at all.
The sad truth is that, on most measures of healthcare outcomes, the NHS lags behind other countries. This has been brutally laid bare in a new report by my colleague Dr Kristian Niemietz for UK2020. Whilst prevalence of diseases and recovery can differ across countries for a range of reasons unassociated with the quality of the health system (socio-economic factors, lifestyles etc), a package of studies and indicators can give us broad insights.
The results are striking. Even if one just hoped that the NHS could raise its standards to the 12th best country across a range of indicators, many lives could be spared. If breast cancer outcomes were the same as in Belgium, 2,504 lives would be saved each year; if bowel cancer outcomes were the same as the Netherlands, a further 3,264 people per year would not die. Similar needless deaths are seen for prostate and lung cancer, whilst around 3,000 lives per year could be saved if British stroke patients were treated in Switzerland rather than here.
A couple of thousand here, and a few thousand there – pretty soon you are talking significant numbers of people. There are areas where the NHS performs comparatively better, of course. Oral cancer in particular. But the overall pattern is clear. Measures of ‘mortality amenable to healthcare’ – premature deaths that could have been avoided with timelier or better healthcare – suggest that 5,594 people die each year unnecessarily. In other words, mothers, fathers, grandparents, sisters and brothers are dying through access to sub-standard or untimely treatment.
We are not even talking about comparisons with the best outcomes in the world here. Yet where are the howls of outrage about this? Whether it’s because few ever experience other systems, or because the public values the intentions of the NHS, or because saying it is taken as an implied slight against the quality of our tireless health professionals, highlighting systematic poor outcomes is just not done. Instead, we cling to the comfort of studies such as that of the Commonwealth Fund which tell us we have the best system in the world, because they examine inputs and procedures rather than outcomes. We blithely ignore the fact that a write-up of the same study, with no hint of irony, said: “the only serious black mark against the NHS was its poor record on keeping people alive.” The only international comparison cited tends to be that showing we spend less on healthcare than other countries, ignoring evidence that the money we do spend is done so inefficiently to delude ourselves we simply have a resource problem.
It’s time to face the evidence. Our healthcare outcomes are unacceptable. We have much to learn from other countries, yet until we accept there’s a major problem, we will merely continue our parochial NHS worship, with the result of continued unnecessary bereavements.
This article was first published in City AM.