Published: 24/03/2005, Volume II5, No. 5947 Page 21

Neil Goodwin says we should stop judging the NHS against other countries' health systems

During election campaigns, the NHS is often compared with other countries' healthcare systems to show how much the English system needs to improve.

But how much truth is there in this approach?

Our love affair with the US health system is well known, but of limited value because of the different sociopolitical values of the US. Closer to home is Europe, and despite our national ambivalence, we are Europeans.

The EU will have more impact on the NHS than any other external factor, if only because it is the largest politically and economically integrated transnational bloc in the world.

In 2000 the World Health Organisation named the French health system as the best in the world and popular opinion would have us believe it is superior to our own.

However, the French failed to cope with the 2003 heatwave crisis. And although the system remains relatively equitable, it is in deficit and becoming inefficient, with waiting lists for routine operations beginning to appear for the first time.

It is not surprising that the French government has promised radical reform, including ending the right for people to consult different doctors for the same complaint.

I mention France's challenges not to rake up historic Anglo-French enmity, but to reflect the increasing importance of the converging health agenda across Europe.

All countries need to manage demand from chronic diseases precipitated by increasing longevity, lifestyle and environmental changes.

It is estimated that 20-30 per cent of adults in Europe are overweight because of poor diet and lack of physical activity, while cardiovascular disease is now responsible for 40 percent of all deaths.

All governments are looking to devise effective and sustainable responses to increasing consumer demand for greater patient choice, better and faster access to services, and the growing number of patients' rights movements.

A 2004 survey of 8,000 Europeans found that people would be willing to travel to another country for treatment (Disney H et al, 2004).

This is increasingly likely now that the European Court of Justice has ruled it reasonable for patients to receive treatment without undue delay and to be reimbursed by their own country under existing EU treaty provisions.

It is not surprising that in the light of these almost unprecedented pressures most national governments are looking for greater efficiency, productivity and cost control from their health systems.

But at the same time they are also reviewing existing authority relationships and distancing themselves from national accountability for local healthcare provision.

Although proud of our national differences, we actually have more in common with the challenges facing our European cousins than we realise. Yes, we do need to compare national health systems, but principally for shared learning purposes.

Perhaps, given the emerging evidence of the declining influence of the medical profession on health policy in industrialised countries, we should start with learning how to minimise the risk of healthcare leaders being squeezed between politically driven reform and resistance from the very professional staff required to implement it.

Neil Goodwin is chief executive of Greater Manchester strategic health authority.

See Good Management, pages 26-27; see also features in next week's issue.