How to 'save our NHS' - look to what works better elsewhere...

Via the Adam Smith Institute, I came across the Euro-Canada Health Consumer Index 2010 report (PDF), which ranks a number of European healthcare systems in terms of their 'consumer friendliness':

"The healthcare systems of Europe can be classified into two distinct models: the Bismarck model and the Beveridge model. Bismarck systems have been described as a “social insurance” model. In these systems, there are multiple different insurance organizations that exist and compete with one another. These insurers are organizationally independent of the healthcare providers in the country. Under the Beveridge model, the financing and provision of healthcare are handled with-in one organizational system. Financing bodies and providers are either wholly or partially contained within a single organization. Britain’s National Health Service, the Nordic countries’ medical systems and Canada’s Medicare system are all examples of the Beveridge model.

Throughout the history of the ECHCI, healthcare systems based on the Bismarck model have been shown to outperform the Beveridge systems. The larger Beveridge systems—Canada, Italy and Great Britain—have consistently been ranked near or below the middle of the indexes. These results strongly suggest that the separation of insurers from providers and the provision of consumer choice are important principles for the development of high-performing healthcare systems—especially in medium- and large-sized countries."

The top-line results of the 2010 index were as follows (p14):

Despite all of the additional billions of pounds that has been sunk into the NHS over the past decade, in terms of the customer perspective the UK resides only 17th in the list of nations compared; indeed of the 'big' EU countries only Spain falls below us.

Is it worth pointing out that Netherlands (#1), Germany (#2), France (#4), Switzerland (#5); Austria (#6); Luxembourg (#8) and Belgium (#10) - i.e. 7 out of the top 10 - all have 'Bismarck'-type healthcare systems?

While I agree with those people who are loudly proclaiming that we need to 'save our NHS', based on the results above I would strongly suggest that they may well be looking in completely the wrong place for the solution...

SuperClinics too popular. NHS response? Shut them down!

There is a story in this evening's London Standard that I had to read twice to check that I had understood it the first time.

Superclinics introduced by the previous government could be phased out because they are proving too expensive for health authorities.

The GP-led health centres are said to be running up bills of up to £300,000 a year each.

This would seem fair enough as it stands - in the current economic climate it would be mad to permit such overspends to continue. However, there's a twist! 

A spokesman said: "As is the case with many other GP-led health centres in other PCTs, the huge popularity of the centre with local people plus the utilisation of the facility by high numbers of non-registered patients, who were all exercising patient choice, far exceeded the predictions made by the commissioners."

Okay, so what actually happened is that the 'commissioners' completely underestimated the popularity of these superclinics. What's been so popular about these superclinics? Seven days a week, 8am-8pm opening? Walk-in clinics with no need for a prior appointment? No need to pre-register? Sounds horrendous - can't see any of that taking off...

And so, we come to the denouement of the piece, which is quite breath-taking:

Duncan Stroud, Associate Director of Communications and Engagement at the trust, said: "The majority of patients who have been using the centres could quite easily have used another service.

"They were mainly patients who hadn't registered with a GP or hadn't made an appointment. They basically created a demand which wasn't there before."

So, in essence, people wanting GP services in London should take what their Lords & Masters give them, and should in no way expect the NHS to actually change to fit their needs. There are lots of existing services - use them and be grateful!

This demonstrates yet again that the NHS is simply not 'fit for purpose' and desperately needs major reform. I won't, however, hold my breath...

Yet more airport security hassle

An article posted by Andrew Gilligan on the Telegraph website today caught my eye: in essence, he has articulated something which I am sure many people silently repeat to themselves over and over while standing in a never-ending queue at airport security, which is a variation of "is this hassle really worth it" (a question posed in increasingly colourful language depending on the length of the queue). Well, apparently not - a key passage follows (emphasis mine):

"In my documentary, Philip Baum, the editor of the magazine Aviation Security International, said he could not recall a single time when a bomb had been found using an airport X-ray machine alone. Airport security, he said, was "theatre", designed to reassure the public rather than to stop bombers. The Abdulmutallab case would seem to support this view.
Many airport X-ray machines cannot, in fact, detect most types of explosives: Baum ran a recent trial for a European government where a woman passed successfully through 24 different airports with the complete components of a bomb concealed on her body."

Gilligan goes on to make the point that airport security starts well before anyone presents themselves at the scanner; quite clearly, it was a failure of intelligence and information sharing by the security services that was to blame for the recent attempted bombing of a flight to Detriot. Having lost count of the number of times I have seen the people supposed to be studying the scanner monitor for suspect items either simply not looking or even chatting with colleagues, even the basics need revisiting!

Of course, this hasn't stopped the authorities from using this as an excuse to beef up security even further, as if flying wasn't unpleasant an experience enough already. Some of the more draconian steps being introduced for flights to the US include:

• Customers to remain seated during final hour of flight

• No access to hand luggage and a ban on leaving possessions or blankets on laps during this hour

Try to remember not to drink anything for the final two hours of your next flight or you may find your trip quite uncomfortable...

UPDATE: Perhaps not surprisingly, it turns out that the new all-body scanners that will now be rushed into our airports at massive expense do not detect a number of different materials, such as those used by the would-be Detroit bomber:

"Officials at the Department for Transport (DfT) and the Home Office have already tested the scanners and were not persuaded that they would work comprehensively against terrorist threats to aviation."