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Tuesday 25th June 2019

Is radical NHS reform necessary?

21st February 2011

John Appleby, chief economist of the King’s Fund, asks if poor health justifies NHS reform.


Health secretary Andrew Lansley sees radical NHS reform as the answer in driving up the UK’s poor health outcomes when compared to the rest of Europe, but is this country’s record really that bad.

Official ministerial briefings for the Health and Social Care Bill say that UK deaths from heart disease are twice that of France. However, figures also show that the UK had the largest fall in death rates from myocardial infarction between 1980 and 2006 of any European country.

If those trends continue, the UK will have a lower death rate than France as soon as 2012 and that will be achieved with a slower rate of growth in healthcare spending in the UK when compared with France.

Recent Organisation for Economic Cooperation and Development (OECD) comparisons show that in 2008, the UK spent 8.7% of its gross domestic product on health compared with 11.2% for France.

The epidemiology for that downward trend is, of course, more complex than spending figures.

Similarly, our performance on cancer has been used as an argument for reforming the NHS but since 1979 rates for lung caner in men have fallen and are now lower than in French men where the death rate peak was in the 1990s.

With breast cancer, rates in the UK have also fallen and are now virtually in line with France.

However, mortality is one thing, survival is another. Furthermore, differences in survival rates may reflect variations in how early diagnoses are made, not the state of healthcare in different countries.


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