Inside Health

If you love the NHS, be proud, but also afraid, writes Professor Harry Burns

Twenty years ago, I was director of public health for Greater Glasgow Health Board. I was asked to speak a conference at Stanford University Business School in California. The conference was on “the future of the American health care system”.

The organiser was Stanford Professor Alain Enthoven who, in 1983, was asked by the Nuffield Trust to study the efficiency of the NHS. His report was published in 1985. In it, he put forward ideas of managed market competition to incentivise NHS stakeholders in order to improve efficiency and responsiveness to patient needs. By 1989, an internal market was in place in the NHS.

The conference was a strange affair. It consisted mainly of companies providing healthcare in the US. There were a few politicians and I was one of only two people invited from Europe. Enthoven introduced me by saying: “The British NHS is an information-free zone, except in Scotland where this guy knows what he is buying!” He had heard of a programme introduced in Glasgow to improve breast cancer outcomes. He assumed the disciplines of the market were involved. In fact, public health doctors, surgeons and nurses were working together using survival data to learn from each other how to make care as good as possible. The market was not involved, and we called this collaboration a “managed clinical network”.

Myself and my fellow European – who was from Maastricht – listened in bewilderment as the Americans discussed the intricacies of their market-based system. As we got into the taxi taking us back to San Francisco airport, we asked each other “what on earth was that all about?” We concluded that they felt the future of American health care lay in getting the World Trade Organisation (WTO) to deregulate healthcare systems so they – the Americans – could bid to run them.

We laughed, of course, because the EU would protect us from these predators. How times have changed! The NHS will be now be subject to WTO rules. When I last checked, WTO rules stipulate that, if a country has allowed a private organisation to tender for parts of a service, then that service becomes open to other countries to bid for. Many private companies have provided services to the NHS so it may be open season for the Americans soon.

The US system is becoming ever-more profit focused. In the US, even if you have health insurance, you might be admitted as an emergency to a hospital or treated by a doctor not on your insurance company’s approved list. It could end up costing you tens of thousands of dollars. Americans seem to get more investigations and procedures than patients in other systems. This may be due to doctors trying to protect themselves from litigation and accusations they haven’t adequately investigated or treated people. It may also be due to a desire to maximise their income.

I’m proud of our NHS as I believe most of our staff are. The doctors and nurses in our managed clinical network increased survival from breast cancer by 18 per cent over the next five years and reduced deaths from other causes by 11 per cent in these women. NHS staff want to do the best for their patients and evidence shows they are good at innovating and improving care when encouraged to do so. Our NHS should be allowed to focus on improving the health and well-being of the population. It should not be sacrificed for ever-increasing profit.

Professor Sir Harry Burns is director of global public health at Strathclyde University