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In Defense of Britain's Health System

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By Ara Darzi and Tom Kibasi
Monday, August 17, 2009

LONDON -- When Britain's National Health Service (NHS) was created in 1948, its founder, the charismatic politician Aneurin Bevan, observed that it was "in place of fear." More than 60 years later, it is fear that dominates the discussion of the NHS in the U.S. debate about health-care reform.

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The myth-making ranges from the misleading to the mendacious to the downright ludicrous. Bizarre allegations of "death panels" denying care to the elderly, doctors unable to make medical decisions and "socialized medicine" fill newspapers, airwaves and the blogosphere. These are, without exception, categorically untrue. When it comes to claims about the health of professor Stephen Hawking, not only have the arguments been distasteful, but those proposing them have been proved embarrassingly wrong.

Here are a few things Americans should know about the NHS:

Every Briton is registered with his or her own family doctor, whom they can see when they need -- without paying a fee. These doctors are independent contractors to the health service and are recognized and rewarded for quality in their compensation -- so they can focus on what works, not just what pays. Expanding on the facilities that are already in place, by next year every community in England will have a physician's office open from 8 a.m. to 8 p.m. every day of the year, and you can simply walk in and see a doctor, for free, regardless of whether you are registered.

In the unfortunate instance that a patient is diagnosed with a dire disease, such as cancer, it often takes only a week or two for a patient to be seen by all the right specialists, complete all the required diagnostic tests and be ready for surgery or other interventions. This rivals the best care in the United States or anywhere else in the world.

Under our NHS constitution, patients have a legal right to choice of provider. That means any provider -- public, private or not-for-profit. By April 2010 our NHS will be the first health system in the world to systematically measure and openly publish the quality of care achieved by every clinical department in every hospital. It means patients will be able to make meaningful, informed choices on what is best for them and their family. Some of this data is already published.

Many of the mischief-making rumors have focused on our National Institute for Health and Clinical Excellence, the clinically led body, independent of government, that gives advice on the effectiveness of drugs and treatments. Call it fiscal conservatism or old-fashioned common sense, but we think you should pay only for what works. At the same time, it should be remembered that Britain's pharmaceutical industry is second only to the United States in its innovation and the significance of its discoveries. The NHS invents and delivers pioneering treatments, from the first clinical use of MRI in the 1960s to leading developments in robotically enabled scar-free surgery today.

Standing in defense of Britain's health service does not mean that we believe it is the right prescription for the United States. It is not for us to propose the solution for America, but we hope that correcting the record on some of the facts about our NHS will help Americans evaluate the real strengths and challenges of our system, instead of focusing on the misinformation spread by fear-mongers. Indeed, none of the proposals for reform -- from President Obama or anyone else -- would create a system that resembles that in Britain. What we share across the Atlantic are a set of common values: a belief that health care transcends the narrow confines of consumerism and is a moral right to be secured for all; and fidelity to the principle that a good society brings its citizens together in common purpose, where hope can overcome fear.

Fear is the weapon of choice for opponents of reform who have no substantive alternative to offer. America spends five times the share of its national wealth on health as Singapore, and yet life expectancy in each country is roughly the same. Even allowing for other factors, it is undeniable that the way a health system is organized and operated makes a difference. Americans fear that countries such as Britain and Canada ration care -- and that such rationing could and should never be tolerated in the United States. Yet 47 million uninsured is quite an extreme form of rationing. So at this moment, the burden of proof falls upon those who oppose change -- for they stand in defense of fear.

Ara Darzi, a former minister of health and a practicing NHS surgeon, is chair of surgery at Imperial College in London and Britain's ambassador for health and life sciences. Tom Kibasi is an honorary lecturer at Imperial College. They can be reached at a.darzi@imperial.ac.ukand t.kibasi@imperial.ac.uk.



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