ScienceWeek

ON THE BRITISH NATIONAL HEALTH CARE SERVICE

The following points are made by Rudolf Klein (New Engl. J. Med. 2004 350:937):

1) Britain's National Health Service (NHS) presents a paradox. It is the only health care system in the rich world that is actively and enthusiastically committed to spending more money instead of seeking to restrain cost increases. Extra tax billions are being pumped into the service by the government at an unprecedented rate. In fiscal year 2002-2003, the budget of the NHS rose by more than 10 percent as part of a long-term fiscal strategy announced by Prime Minister Tony Blair four years ago. The aim of the increases is to bring spending on health care up to the European Union's average of 8 percent of the gross domestic product. At the same time, an ambitious process of self-transformation is under way. Founded in 1948 as a technocratic, paternalistic service, with scarce resources allocated according to medical and bureaucratic criteria of need, the NHS is now being redesigned as a consumer-oriented service.

2) Despite the additional money flowing into the system and despite the enticing vision of a service that combines health care that is universal, comprehensive, and free at the point of delivery with choice, flexibility, and responsiveness, controversy and discontent still dog the NHS. The medical profession has diagnosed itself as suffering from poor morale. The public remains skeptical. In a recent poll, 69 percent of those interviewed said they believe that the government is not improving the NHS.(1)

3) The paradox is all the more puzzling because there is considerable evidence that more money has indeed meant better services. The government's report on progress as of April 2003 claims substantial improvements.(2) Since 2001, an additional 17,000 nurses, 2000 therapists, 1200 consultants, and 400 general practitioners have been recruited. New medical schools are being launched to train more doctors. A new style of diagnosis-and-treatment centers, designed to provide quick day surgery, are being opened. Services for patients who have coronary heart disease are being modernized and expanded. Long waiting times, which have been the NHS's most notorious failing, are declining. So, for example, the number of people who had to wait for more than a year for an operation fell by 68 percent during the past year, from 29,600 to 9600.(3-5)

References (abridged):

1. Anyone see where the money's gone? Economist. May 8, 2003:27-8

2. Delivering the NHS plan -- expenditure report. London: Department of Health, April 2003

3, Getting better? A report on the NHS. London: Commission for Health Improvement, May 2003

4. Secretary of State for Health. The new NHS: modern, dependable. London: Her Majesty's Stationery Office, December 1997

5. Robinson R, Le Grand J, eds. Evaluating the NHS reforms. London: King's Fund Institute, 1993

New Engl. J. Med. http://www.nejm.org

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