The Primer provides a rapid guide to the most interesting comment and analysis on the English health and care sector that has not (usually) appeared in HSJ.

Marathon not a sprint

We have barely heard a government minister talking about anything this year without them crowbarring in a reference to the UK’s successful covid vaccination programme.

Not only does it distract from earlier failings in the pandemic, but in the year that Brexit finally happened, it has also provided a favourable comparison with the sluggish EU programme.

But after a slow start, the EU now seems to be catching up quickly.

The Financial Times notes how the bloc has now overtaken the US in terms of first and second doses per 100 people, and reckons it will surpass the UK within a few weeks. Spain, Portugal and Denmark are already ahead.

The article says “hesitancy” is now the main constraint in the vaccination race, but this appears to be less of a factor in the EU, where the current rate is now double that of the UK.

The FT adds: “The racing start to inoculations in the US and UK at the beginning of the year made for an unflattering comparison with an EU reputed to be slow and bureaucratic….

“But Europeans can take comfort: having lost the sprint, they are well placed in the marathon.”

Ministers may need to start thinking of a different success story to divert to when being interviewed.

Waiting list dilemmas

As attentions start to turn more regularly to NHS waiting list backlogs, the Scottish government has come under fire for tasking its hospitals with delivering 110 per cent of pre-covid elective activity within the next year.

The British Medical Association said the plan “looks optimistic”, with various other bodies concerned about the levels of capacity available to deliver the target.

Among the critics is Sir Harry Burns, a former chief medical officer for Scotland who is now a professor at Strathclyde University.

In a piece for The Scotsman, he recalled Julian Tudor Hart — the hero of many a GP, who practised in a small village in Wales, and was “part of his community and knew the people as friends rather than patients”.

By combining scientific medicine with “the art of empathy and understanding”, Sir Harry suggests Dr Tudor Hart, who he met, contributed to a mortality rate which was 30 per cent lower than neighbouring villages.

His point, is that if the health system gets overly focussed on volumes of patients, then this might not be the best thing for overall patient outcomes.

He says: “As [the NHS] tackles the resulting backlog of investigations and operations the pressures will be to focus on guidelines, protocols and getting patients through the door.

“Will the support of patients through empathetic and understanding consultations suffer? I suspect it is already suffering.”

This could provide food for thought south of the border as well, where the funding and waiting list expectations for the second half of 2021-22 are currently being thrashed out.

In Scotland’s case, it might help their waiting list efforts if there was a more relaxed attitude to using private sector capacity, wrote specialist health journalist Henry Anderson in a piece for HSJ. Not something that Sir Harry, and perhaps Dr Tudor Hart, would rush to agree with, though.

Comparing notes

A US documentary series which examined several health services around the world has been nominated for an Emmy award.

In the series first aired last year, PBS News Hour sought to compare the US system to others around the world, including the NHS.

Correspondent William Brangham noted how the NHS spends “less than half what we spend”, including “a lot less on administration costs”, yet life expectancy in the UK is still higher.

However, he also referenced a “series of scandals” about emergency departments overflowing and “hundreds of thousands” of patients stuck in the back of ambulances for more than an hour.

He also spoke to a pensioner in Dorset who had been waiting more than a year for a knee replacement operation, who told him that patients who did not need life-saving care were “invisible”.

But the show’s expert Ashish Jha, dean of the public health school at Brown University, summed up: “We could learn a thing or two from a fully funded version of the [NHS] system; access for everyone; transparent cost controls and people rarely going broke because they’ve got sick….

“But where I think we get lost is the idea that somehow we could take the NHS and just import it into America.

“I think what’s really lost is all that context, the history behind the NHS, the meaning people assign to it. We don’t have any of that. But there’s a lot we can learn and there are strengths of the NHS we could absolutely do better with in the US.”