Saturday, July 15, 2017

Numero Uno?

Its that time again…the Commonwealth Fund has reported- comparing different health economies- and the verdict is pretty straight forward…the United kingdom Health service stands as Numero Uno.
You don't have to believe me- have a look: http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror/#chapter5

Predictably it has drawn a variety of reactions- and depending on your level of confirmation bias, it has ranged fro "See, we are the best!" to "We are the best inspite of reduced funding-arent we glorious?". I say its predictable as in 2014, when a similar report came out, we did pretty much the same- we are the best, we don't have much to learn from anyone- all is well, happy days are here again. I suspect its an indictment of our times, when we as clinicians, born and brought up on the bread and butter of constructive critique have now been sucked into the realm of instantaneous judgements- all that matters are the headlines- little heed to the details below.

So lets dig a bit deeper, shall we? Lets start with the good news- have a look:
Makes you proud, doesn't it? Top of the tree- amongst many nations- the USA lagging behind- and maybe its time we stop actually looking at that- and perhaps closer to the continent. Anyway, I digress- this graph is sure to cheer many
But what about this one? Click on the bit called "Health outcomes"- and this appears:
Now thats not that good- so whats going on? We come trip of the tree in aggregate, yet when it comes to the actual nub of what matters, we just about pip the USA. So is this all a smoke screen- and statistical quirks or something we worry about?
I would suggest we all take our time and go through this- there is the worrying bits- when you look at say 5 year Colon cancer survival bit:
…yet when you look at 10 year decline in mortality, the results for the UK are sparklingly good
Finally, if you breakdown all of how all the different countries have actually performed, it makes for fascinating reading…
What does it tell us? Great at process, fabulous in equity (no question NHS tops everyone on that), good in administrative efficiency and access, yet poor in healthcare outcomes- albeit given the fact in certain areas chosen. We could debate this forever, but its not as clear cut as "we are the best" or "no, we really aren't". It does however create an amazing space for discussion. What does the report itself say? Read it- and draw your own conclusions


Then to the bit which gets everyone going…what about funding- again, draw your own conclusions from the graph below- but the picture it paints- considering everything is fascinating.
Overall, its a report which I hope provokes debate rather than siloed views. I have always maintained the NHS is a fabulous health system - conceptually- yet there are many areas we could improve on. To say that doesn't mean I don't "love the NHS" or want to "privatise it"- but simply that I am keen to improve things as they are. Outcomes is why I do what I do- I don't see my diabetes patients to improve their HbA1c, I do whatever I do in the hope i can prevent them from going blind, or lose their limb, have a happy life…as simple as that.

Finally, I will leave you with this to reflect on. Below is the last report summary- we all rejoiced in delight when we saw this- delighted that "The NHS was Numero Uno". What we missed was the detail. The report also said we were nearly the last in keeping people healthy. In short, we were great at looking after folks when they got ill…we just weren't good at keeping them healthy. And in a finite financial system? At some point, the burden of illness will crack it all apart.

This time, it would be good if we could debate this report- with some light, rather than simply heat. We all need to go back to having debate- allowing others to express their views- with respect and decency. We all need to do this- if we genuinely all want to make the NHS Numero Uno.

I live in hope.

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