For the second year in a row, the NHS has come out top in an international comparison of health systems published by respected US think tank the Commonwealth Fund. So what does this really mean?
The Fund gives the NHS a glowing report, ranking it the world's best health service in terms of safety, equity and affordability, and in the top three for efficiency and ease of access to care. The NHS beat ten other health systems to the top spot - with Australia and the Netherlands close behind in second and third, and the US ranked last by some distance.
If nothing else, it's a welcome reminder that despite the many challenges facing the NHS, we are extremely lucky to have it. Wherever you are in the UK, you can rely on pretty fast and efficient access to world-leading care, without having to worry about being left with an eye-watering medical bill or hefty insurance payments.
There are no upfront charges (such as the GP appointment fees paid in France, Australia and Germany) and everyone is covered - unlike in the US where an estimated 24 million people remain uninsured.
More than anything, it's a testament to the remarkable dedication and effort of the NHS's 1.2 million staff, who are often put under huge pressure. But as those pressures escalate, there is growing concern that the NHS could struggle to keep its status as a world beating health service.
Firstly, it has been well documented that the NHS is under significant financial pressure. ‘Affordability’ is a double edged sword: in terms of spending on healthcare, the UK ranks fourth from bottom of the countries included in the Commonwealth Fund study.
Separate BMA analysis has shown that the UK spends around £10.3 billion less than other leading European nations, and that based on current spending plans this is set to leap to £23 billion over the next five years. Since its creation in 1948 the NHS has received annual real terms spending increases of around 4 per cent, but since 2010 this has dropped to roughly 1 per cent.
This funding restraint is now taking its toll. In England, the number of hospital beds per patient fell from 3.8 in 2000 to 2.4 in 2015, and the number of overnight beds has decreased by a fifth since 2006/07. The Department of Health’s target of 95 per cent of ambulances arriving within 19 minutes has not been met for 23 consecutive months.
At the same time, demand is growing. Last winter was one of the toughest on record for the NHS, with 16,000 more A&E admissions than the previous year. Unsurprisingly, patients are waiting longer to be seen in A&E and are more likely to experience long trolley waits once they are admitted. In primary care, a fifth of patients are now having to wait a week or more to see a GP or practice nurse; 7 per cent higher than in 2012.
To some extent these pressures may be a factor in why the NHS has scored lower in the Commonwealth Fund's comparison of health outcomes (which looks at things like morbidity rates and life expectancy). The UK ranks second from bottom against this criteria, suggesting that as a society we need to do some serious thinking about how we can lead healthier lives and do more to prevent ill health.
In the face of such a challenge, we should be investing in transforming our health service to keep people out of hospital wherever possible. Instead, funding for public health and social care has been drastically cut.
Large chunks of funding set aside for ‘sustainability and transformation’ in England have been used to plug holes in hospital finances, and local decision makers have been told to find £26 billion of funding efficiencies. Most recently, 14 areas in England were told to ‘think the unthinkable’ and consider new ways of rationing care such as closing services and making staff redundant to save money.
The NHS turned 69 last week. Will it last another 69 years? The next five years could be crucial to its future, as pressure on the system grows and funding restraint continues to bite.
The Commonwealth Fund report doesn't quite tell the whole story about the challenges facing the NHS in 2017. But it does demonstrate one thing: it's definitely worth fighting for.
Jonathan Ware is head of health policy at the BMA
The NHS was founded in 1948, when there were enough gold reserves in the treasury in the UK, for many reasons. Everything changes in this world all the time except this principle (Aristotle). The winds have changed. Diminishing national financial resources are the reason for decreased funding for the NHS and Defence Forces, by the elected British Government , who are also patients themselves. The British Nation has to live within its means, come what may, as Rt Hon Theresa May says! Borrowing money from abroad is a threat to all departments, especially for future generations. Luckily, the British Medical Association is the only, and the best, trade union for all doctors. British politicians are also the best politicians in the world. This is an appropriate time to negotiate behind closed doors, out of sight of media. Negotiation would pay and agitation would not pay for the NHS and devoted doctors. Every medicine has side effects, we negotiate and not agitate, so as to serve the patients and save lives. Trainees need to learn that the NHS is a result of negotiation of elder generations, after free and open discussions. I hope and wish that common sense prevails and our BMA leaders persuade politicians , of all parties, to run the NHS as best as possible. Doctors and politicians are all patients; there is a need for mutual dialogue with give and take. I have been serving the BMA and the British Nation since 1964; I noted that everyone respects the BMA. Let us use wisdom and not tension in negotiations. I hope we stay away from agitation and anger. The British patients, the Government and the BMA can keep the NHS at its best even with less finances while trying to obtain more resources for the Nation. Dr Bashir Qureshi, Life Member and an ardent supporter of the BMA.
As a campaigner desperate to stop the destruction of our NHS in favour of a US style, for profit, health business - I am pleased to read your comments but remain concerned that too often for the public the BMA has failed to support their members. Standing on the picket lines with Junior Doctors showed me the lack of faith many had in their professional union and seeing the dreadful dumping by the BMA of Dr Chris Day, confirmed my agreement with them. Why would Dr. Porter and the BMA not support a young Doctor's fight to ensure protection for all whistle blowers within the NHS? No sensible NHS supporter wants an outdated NHS but the BMA could lead the fight for a modern service with full governmental responsibility for its delivery and transparency and accountability in its operation. Lacking this lead we the public remain suspicious that privatisation is the goal for too many within the medical profession.
I believe over the next few years as spending cuts start to bite ever more deeply the NHS will cease to exist in it's present form as more health services are privatised we will move to a US style insurance based system which leaves poorer people with very little access to healthcare services sad times
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