Improvement in the NHS

I gave a talk at Civitas yesterday. Afterwards, Julian Le Grand who is a senior adviser to the government on the NHS, said that it had been an insult to the intelligence of those assembled. Fortunately it was an insult they bore bravely – all of them, except Mr Le Grand, staying to the end, offering compliments and, in several cases, buying two copies of the book.
His substantive points were – and please forgive me if I am unable to remember them all or to do them justice:

1. MRSA is an even bigger problem in Japan and some other country which I am afraid I forget. So ‘what do you make of that?’
2. Britain’s record on heart disease is improving faster than in any other country.
On the first point, I would be interested to know more about the circumstances in those other countries. I have not seen the research he is basing his remarks on. Meanwhile, there is no proper and reliable evidence of the number of deaths from MRSA in Britain to compare with those in other countries. In its reports, the National Audit Office demands a proper system of reporting but so far has not got one. It is therefore difficult to claim that MRSA is worse in other countries when we do not really know how many deaths it causes or contributes to here. In fact we have the word of various doctors who have said previous and very recently that it is perfectly possible for MRSA to contribute to or cause the death of someone without it being recorded as the cause of death.
In the book, among the many pieces of research I referred to was that in the European Microbial Resistance Surveillance System bulletin, 2002. That shows that the percentage of Staphyococcus aureus samples taken in hospitals that are resistant to antibiotics (ie MRSA) is vastly higher in the countries around the Mediterranean than in those in northern Europe. But there is one exception to this rule. In Britain, the proportion of MRSA was 46.3 per cent – above the levels even of the Mediterranean countries and far higher than that of other northern countries. In Finland and Sweden there was one per cent. In the Netherlands, there was zero.
Meanwhile BMI Healthcare, which runs a large number of private hospitals in Britain, has publicly declared that it has had absolutely zero cases of blood-borne MRSA. This suggests that the problem of MRSA in Britain is mostly something to do with the NHS rather than something to do with the character of Britain. I know excuses will be found. The ‘patient mix’ is different in NHS hospitals. But the difference between thousands of deaths a year in NHS hospitals and none in BMI hospitals is surely too great to be explained away just by ‘patient mix’.
Mr Le Grand’s second argument, that Britain’s record on deaths from heart disease is improving faster than anywhere else in the world, was undermined by his subsequent aside: “admittedly from a high base”. It is rather like a man saying, “I am getting sober at a faster rate than anybody else”. An extremely drunk man could say that, while someone sober would regretfully have to admit no improvement at all.
Going to the underlying thrust of Mr Le Grand’s remarks, which probably is that the NHS is improving, I would say:
- in some areas, especially those on which the Government and the press are focused, it probably is indeed improving.
- much of the improvement, in waiting lists for instance, is largely due to buying in operations from the private sector, hardly a vindication of the NHS model.
- the NHS remains very much inferior to other medical care systems around the advanced world
- other areas of medical care that are not the focus of Government and press attention are probably continuing to deteriorate. Only today we learn that NICE intends to recommend that the NHS should stop offering drugs which reduce the impact of Alzheimer’s disease.
- the improvements so far are not commensurate with the large amount of money spent.
- as Reform has demonstrated, there have been far bigger increases in management and administrative staff than in medical staff. This does not augur well.
A friend who is close to one or two of the senior people in charge of NHS tells me that there is a view in those quarters that this is the last chance for the NHS. If it does not show major improvement over the next two years, its reputation may be damaged terminally.

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