King's Fund challenges health reform claims

Andrew Lansley has said the UK’s outcomes when it comes to health issues such as heart attack and cancer are among the poorest in Europe, despite similar spending.

But John Appleby, chief economist at the King’s Fund think tank, has now challenged these claims and calls for a cautious interpretation of the evidence.

While UK heart attack rates in 2006 were twice those in France, the UK will actually have lower rates by 2012 if trends continue, he wrote in the British Medical Journal.

“Comparing just one year - and with a country with the lowest death rate for myocardial infarction (heart attacks) in Europe - reveals only part of the story,” he said.

“Not only has the UK had the largest fall in death rates from myocardial infarction between 1980 and 2006 of any European country, if trends over the past 30 years continue, it will have a lower death rate than France as soon as 2012.

“These trends have been achieved with a slower rate of growth in healthcare spending in the UK compared with France and at lower levels of spending every year for the past half century.”

In 2008, the UK spent 8.7% of its gross domestic product on health compared with 11.2% for France - 28% more, Mr Appleby said.

He urged caution when interpreting figures for health outcomes because the “trajectory for many causes of death swoops up and down over decades - often linked to changes in lifestyle behaviours rather than spending on healthcare”.

He added: “Our apparently poor comparison with other countries on cancer deaths has also been a key argument for reforming the NHS.

“However, comparisons are not straightforward and depend where you look.

“Death rates for lung cancer in men, for instance, rose steadily to a peak in the UK in 1979.

“But since then they have steadily fallen, mirroring long-term changes in smoking patterns, and are now lower than [rates] for French men, where the peak death rate occurred over a decade later in the 1990s.”

Turning to breast cancer, it is likely that the UK will have lower death rates than France in just a few years, following recent trends, Mr Appleby added.

Data also suggests that survival rates for cancer in the UK have been improving, the economist said.

“Furthermore, differences in survival rates may reflect variations in how early diagnoses are made, not the state of healthcare in different countries.”

Health minister Lord Howe said: “Improvements in outcomes have continued under various governments, but there is a wealth of research which demonstrates beyond doubt that UK health outcomes are relatively worse than they could be.

“For example, if cancer survival rates matched the European average, 5,000 extra lives each year would be saved.

“The NHS needs to respond to the challenges of the 21st century.

“Modernisation is a necessity and not an option if the NHS is to keep up with the increasing demand on services, an ageing population and rising costs of new drugs and treatments.

“Our proposals will put the NHS on a more sustainable footing for the future, empower clinicians to design services in the best interests of patients and ensure it is comparable to the world’s best-performing health systems,” added Lord Howe.