International pride

The media has once again been preoccupied with the NHS, this time to defend it against vituperative attacks from US Republican opponents of President Obama’s public health reform proposals.

As has been pointed out, it is okay for us Brits to grouch about the NHS, but no foreign persons are allowed to join in this particular debate. The argument has moved our own political parties (with the exception of ‘eccentric’ Tory MEPs) to proclaim that funding for the Service will be maintained at all costs while the national debt continues to mount.

It is of course true to say – as The Sun did – that most people in the UK can’t remember what life was like before 1948, but even that august journal was moved to point out that NHS dentistry still has us ‘grinding our teeth’. The article went on to point out that in the World Health Organization national rankings[1], the UK came 18th and the US only 37th. Which led me to wonder who was number one.

Well, I’m afraid to say it’s the French, closely followed by Italy, San Marino, Andorra and Malta.
Can we learn anything from this? It’s always dangerous to generalise, but the top few don’t have a universal, publicly funded approach, and none ranks high, to my knowledge, in the dental tourism market.

The US system is, by any standards, bi-polar. For insured American citizens, generally high standards of care are available, but for the estimated 55 million uninsured, the Federal healthcare safety net can vary from minimal to non-existent. Moreover, the private dental market is significant for-profit insurance interests with mandated or discounted fees.

Here, despite the understandably reassuring statements by politicians of all parties, the fact remains that the PCT funding allocations are set at annual increases of 5.5% for this year and next, according to the NHS Confederation[2]. The real prospect of little or no cash increases beyond 2011/12 will, they say, lead to a fall in real-terms funding by 2.5-3% per annum.

The leadership challenge this represents will, in turn, call for major policy change. The Confederation believes that ‘slash and burn’ policies (such as that recommended by McKinsey earlier this month, and promptly rejected by ministers) are inappropriate. But, they concede, where large efficiencies can be realised, a ‘more disruptive approach’ to change may be needed to extract the ‘productivity dividend’ embedded in some services.

The conclusion of the NHS body which represents commissioners is stark: facing up to the greatest challenge the service is ever likely to face will require bold solutions and major change.

It is not only President Obama who faces a significant challenge in the years to come.

1. WHO World Health Report, World Health Organization 2008
2. Dealing with the downturn: the greatest ever leadership challenge for the NHS? The NHS Confederation, June 2009.

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