'So as we head into TUC and party conference season, by comparison things actually look pretty tame here. Part of the problem is the way international health comparisons are used - and abused.'
In most of Europe it is possible to combine equitable funding with more plural provision.
August, and the summer holidays are upon us. And so, if the papers are to be believed, is an upsurge in union unrest.
Of course, work is the last thing you want to think about on holiday. But perhaps I can suggest a mild tonic to boost your spirits when you head back home? As you hang about in some European airport waiting for your delayed Easyjet flight, or queue up to board the ferry back to England, take a quick glance at one of the local newspapers. You will be pleasantly reassured to find that compared with most of our Continental neighbours, the NHS is a haven of industrial unity and tranquility.
A Continent in struggle
For there in graphic detail you will read of French surgeons who began an open-ended strike on 24 July for higher fees (the strike began during the heat wave as hospitals overflowed with extra patients and affected two-thirds of France?s 900 clinics). And you will discover that, within the past month, hospital doctors in three German states have also begun indefinite strikes for higher wages.
This follows three months of strikes across German teaching hospitals, not to mention the recent report that one in three hospitals faces bankruptcy under the new tariff system. Oh, and don't forget the indefinite strike just launched by pharmacies across Italy.
So as we head into TUC and party conference season, by comparison things actually look pretty tame here. But so much for comparative health policy, Zinedine Zidane-style. Because part of the problem is the way international health comparisons are used - and abused. Think about any recent newspaper article and you will see that it aims to do one of three things:
- confirm the superiority of the NHS by emphasising the defects in every other country's system, or:
- prove the wholesale inferiority of the NHS, to justify why it should be replaced lock, stock and barrel by employer-based social insurance or some such scheme, or:
- occasionally to learn from other countries' successes and failures.
A bit less of the first two and a bit more of the third would make a big difference. And arguably that is what we have been quietly doing here over the past few years. Recent controversial NHS reforms have explicitly borrowed ideas from other European countries, including foundation trusts (a hybrid of Continental models), cross-charging local authorities for blocked hospital beds (Scandinavia), and patient choice (almost everywhere else).
And more generally, there is recognition that in most of Europe it is entirely possible to combine equitable healthcare funding with more plural provision.
Pick 'n' mix improvement
So rather than the 'Americanisation' of the NHS (whatever that daft slogan actually means) it might be more accurate to talk of its 'Europeanisation'. But not in an uncritical way - simply a magpie-like approach in which we look, learn, take the models and reforms that work, and pass on the rest.
So what do the European comparisons tell us? It is a rather complicated picture. The World Health Organisation's infamous attempt at a global ranking in 2000 made the French feel good - until thousands of pensioners expired in a summer heatwave. We know that until recently we have been spending less than our European partners (in fact,£220bn less during the final quarter of the 20th century), and that in turn has meant we have relatively few doctors and relatively old infrastructure. And we know that our waits are longer and our patients often less satisfied with responsiveness.
But what we do not have is a good fix on is how our clinical outcomes compare. Most of the data is out of date by the time we get it. For example, cancer survival rates - a favourite of the Daily Mail- typically measure survival five years after people have been diagnosed and treated, so at best reflect the state of cancer care before the NHS plan and its related investment came on stream in 2000.
The more interesting underlying question is whether it will be governments which 'spread best practice' between European countries' healthcare systems - or whether this will be driven by the European institutions or indeed the choices individual citizens make.
There are good grounds for scepticism about the prospects for convergence in entitlement or rationing decisions between EU member countries. Even putting aside questions about the constitutional and political desirability of this approach, with the expansion of the EU to 25 countries the spending differences between western Europe and the accession states is just too great.
A harmonised healthcare 'benefits package' that would be acceptable in Germany is unaffordable in Slovakia and vice versa. That does not mean that once a country has decided what healthcare its citizens are entitled to there should not be competitive provider markets or that patients should not be able to choose where to receive care.
And this is precisely where the European Court of Justice appears to be taking us - in the first instance chipping away at the idea of rationing by waiting. As the Luxembourg judges said in May: 'To be entitled to refuse a patient authorisation to receive treatment abroad on the ground of waiting time for hospital treatment in the state of residence, the NHS must show that waiting time does not exceed a medically acceptable period having regard to the patient's condition and clinical needs.'
And over time we can probably expect an ECJ-led extension of the single market and other rules to wider healthcare provision - taking them well beyond their current application to junior doctors' working times, competition in medicines, the free movement of health professionals, and the like.
So over time it seems likely that our health policy, like our holidays, will have an increasingly European flavour. Perhaps minus the summer strikes?
Simon Stevens is president of UnitedHealth Europe and was the prime minister?s health adviser.