The NHS rarely looks to other countries for inspiration or lessons to learn. Forays overseas tend to be confined to the US, where the parallels, certainly at a wholesystems level, are least appropriate.
Developments in Canada and Australia, not to mention Europe, receive scant attention. The NHS, basking in splendid isolation, may be happy to advise others but remains remarkably impervious to learning from them.
No healthcare system is an island. If this ever was the case it is no longer so.
Healthcare systems may continue to diverge over matters of funding and organisation, but in the sphere of policy there is growing convergence in the issues, themes and slogans being pursued.
For the most part the various initiatives are not evidence-based (though elements may be), so they can only be the product of global fashion and the influence of international management consultants and agencies like the World Bank.
In their governance, the Australians may have decided to hang on to nurse (ie the Queen) for fear of something worse, but in the area of healthcare reform, they are as active as any nation in subjecting their healthcare system to scrutiny, even if it has not yet gone far enough for some.
The faltering pace of reform may be a product of the awkward split in the health function between the federal and state levels.
At the end of a month-long visit to Australia at the invitation of the Commonwealth Department of Health and Aged Care, it is striking to observe both how divergent and convergent the international reform agenda is. The obvious main differences lie in the federal system of government and in an uneasy public private mix which has spawned a variety of perverse behaviours among clinicians and others.
The Australian healthcare system has been aptly described as a 'strife of interests'. But, for all its deficiencies - especially the poor quality of care received by the indigenous groups - the UK could be heading for such a model as devolution begins to bite and as private healthcare assumes greater significance as a means of easing pressure on a public system allegedly starved of investment.
If a significant for-profit private health sector becomes established in the UK alongside the NHS then some of the tensions and malfunctioning of the Australian system could also emerge.
Australia may lack a national health strategy - a source of frustration for those seeking to establish a coherent federal health policy - but developments are under way which have much in common with the NHS modernisation project.
A centralised NHS is envied by those trapped in the federal-state gridlock, with its endless possibilities for costshifting and 'gaming'. On the other hand, the vibrancy and creative impulses evident at a state level in Australia may be seen as a source of political strength. If the 'third way' means anything it is surely about trying to reach an accommodation between these two extremes. So far, in the UK, the government has uncompromisingly opted for firm top-down central control to deliver on its agenda.
In Australia such an approach is not on offer, and while it is frustrating for those at Commonwealth level, the vigour and energy evident at local level is something to behold when you are accustomed to subnational agencies in the UK - even elected ones - that have been reduced to rather spineless administrative outposts of central government.
Neither system may represent an ideal but perhaps each has lessons to offer - in much the same way as Canada does. Here, something approaching an optimal central-local relationship, notwithstanding Quebec, appears to exist.
Despite the paralysis gripping aspects of the Australian healthcare system, many interesting developments are occurring. For instance, New South Wales is trying to build capacity for health by recognising the need to strengthen social capital and develop appropriate management skills and competencies.
And the national co-ordinated care trials initiative - about to enter its second phase - is being extensively evaluated. Much in these trials bears an uncanny resemblance to New Labour's rhetoric about a primary care-led NHS and its emphasis on integrated care.
It is enervating yet sobering to see different countries tackling similar problems deploying the same or familiar instruments. Somehow finding sustainable solutions continues to elude healthcare reformers.
There must be a way of capturing the knowledge gained across healthcare systems and using it to inform policy changes in various countries, shortcircuiting the wasted energy expended on the search for bespoke solutions and, in the process, needlessly reinventing the wheel.
Perhaps the requisite solution is also one that politicians globally seem to find so hard to accept: investment in publicly funded healthcare systems and a refocusing of health policy towards preventive interventions.
In practice there is a dislocation between the content of healthcare reform and the goals of health policy at a macro level. Until the two are realigned, policy makers will continue endlessly to process problems without solving or preventing them. If this is the future promised by globalisation and the 'new capitalism', it is one to be firmly rejected before it is too late.
A new politics is to confront successfully the public policy challenges posed by globalisation.
Everywhere politicians lack boldness and vision, and appear little different from the technocrats and managers they ostensibly exist to oversee.
The country that can break the mould and offer an alternative political paradigm, combining vision with leadership, will richly deserve to be copied.
David Hunter is professor of health policy and management at Leeds University's Nuffield Institute for Health
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