The British NHS healthcare system is considered the world’s benchmark. Its services can be used by all citizens of the country, and NHS doctors take care of virtually all diseases. As in Britain, they managed to create a system that almost everyone is happy with. Interview with Chris Bourne.
Chris Bourne: This is a public health care system. Thanks to this system, citizens do not have to pay for services in medical institutions – with some exceptions. There are a couple or three services that you have to pay for, but most of them do not. Most Britons use it and are registered with it, and every citizen can use its services. So: most of the medical services are provided by the state, although there are several areas, which are served by private individuals. This is an impressive structure. At the local level, it operates partially autonomous – of course, according to national standards and directives.
You have managed the whole NHS system – you have seen how it works from the inside. Do you think the public health system is better than the private one? Or is private more efficient?
It depends on what you want to achieve. If you compare the existing public health systems, we will see that the British system works well. It is not perfect, and there is certainly a lot to do to make it better, but above all, it is available to everything that cannot be said about health care in some other countries. It is effective – the patient satisfaction rating is high, that is, people like the service and the result.
And all this is at a reasonable price. The economic efficiency of the system is comparable to the level of other developed countries; it is one of the best in the world. And it is said not only by the British, but also by the American think tanks. At the same time, the private medical sector is also important, because it gives people a choice. The state pays for some private medical services, so they are necessary. But most of the medicine is public.
What services do not the government cover in Britain?
Most of them are covered by the state. Both primary and secondary health care is available, as well as specialized medical care. There are very few services that the system does not provide. For example, it is cosmetic surgery – unless of course there is a special need for it. IVF services are available, but you get a limited number of attempts to get pregnant.
If you want to make more attempts, then you may have to go to a private clinic. So – yes, there are examples of services that NHS does not provide, but there are all that are absolutely necessary to solve your health problems.
Of course, you can ask questions about new drugs and treatments. We have a system that evaluates them and decides whether they should be available from the NHS. That is, at the moment, some new treatments may be evaluated for their financial effectiveness. But, again, these are minuscule exceptions compared to the amount of services that the system provides.
What about the treatment of cancer patients?
Most of these services have no limitations. As I said, some new drugs can be examined for financial effectiveness. For example, if such a drug prolongs life by one or two weeks, it is necessary to assess whether it should be offered under the NHS.
At the same time, if a person is dissatisfied with the service’s decision, he may appeal against it, stating some special reason why he needs this unusual drug. So, most of the medicines for cancer patients are available through the NHS.
The NHS has a lot of problems: crowds of people go to appointments, patients die in lines… Is this true?
Yes, hospitals are sometimes crowded, but there are no crowds. Of course, there are different cases – for example, in the cold season there are more patients. In addition, the population of our country is getting older, we have such problems as obesity, alcoholism and the like. Therefore, it happens that by coincidence, the hospital can really gather many patients.
But patient safety is an absolute priority for everyone, so the chance that someone will get hurt within the system is very low. It is extremely safe. Of course, as everywhere else, a small percentage of mistakes happen, and long waiting is not the most pleasant experience for the patient. So, yes, there are problems, but what you have talked about happens very rarely, and of course, in everyday practice NHS tries to prevent this possibility.
Okay, queues are not the main problem. Then, what is the main problem? Are there any problems at all?
Oh, there are plenty of them, as in any other health care system. First of all, they are resources, which were recognized by our authorities a year or two ago. We need more money. If we can say so, we find that NHS “inflation” is higher than usual – due to the increase in the number of patients, their needs, new treatment methods and technologies. Therefore, more resources are always needed. Undoubtedly, we need to be sure that we can pay for and support our staff.
For several years, funding for NHS has been relatively static due to the financial crisis, and now significantly more funds are being invested in the system. Resources are important, and almost everyone will tell you that it is important to invest in medicine.
If we talk about staff, I think there are areas where it is difficult to hire the right specialists. But this is also true for the rest of the world – and we can talk here about their global shortage. In order to attract people into the profession (or to attract them back after they’ve taken a break in their career), a lot of efforts are being made, but there are indeed some problems with this.
And finally, there is the difficulty of bringing new ideas, treatments, innovations and technologies into the system. It is hard to make the whole system accept them. Innovations are very important, but it is not easy to promote them.
There are many migrants working for NHS. Won’t it be a problem to hire them after Braxit?
Yes, the British healthcare system is indeed very dependent on foreign staff. They are not only Europeans – for example, we have many workers from India and just people with Indian roots. Yes, the opportunity to hire specialists abroad is extremely important for us, and we are always happy to hire them in the UK.
But we are looking for new systems with which we can increase the recruitment of medical professionals in certain specialties here, without taking away qualified specialists from countries that need them. People will be able to come to the UK, fill an appropriate vacancy, earn money and also learn a lot from their profession and then return to their country with more experienced specialists.
As for the European Union… How EU citizens will get to Great Britain in general after Brexit is being discussed, and I am sure that there will be an adequate answer to this question. For example, in our visa system there are visas for representatives of professions in which the country lacks. This list currently includes several medical specialties, including nurses. So in any situation we will be able to find a solution, if necessary.
You mentioned the difficulty of introducing innovations into the system. Is it about bureaucracy?
That’s a good question. We give partial autonomy to our field offices. Each hospital – or group of hospitals – is managed by a separate organization, the NHS Trust. Such a public organization has its own board of directors and is accountable to the local population through representatives of the authorities, but operates according to national policies and standards.
It seems to me that this approach helps to implement innovations at the local level more quickly. But at the same time, we believe that such processes need to be partially controlled and monitored, say, the way new technologies are introduced in the NHS in general. In general, this is a mixed management – at the local and national levels. At NHS, we encourage entrepreneurs and innovators. We have special programs, such as the NHS Innovation Accelerator, which is designed to help people who come up with new ideas to test and implement them in the system.
At NHS, we work with the problem of bureaucracy. We have very low management costs compared to the health systems in other countries. But of course, the question of how to get the clinic staff to innovate is eternal. We try different approaches in order to find the best in the end.
In the United States, there are constantly fierce battles around public health. Democrats want to provide “medical care for all,” and Republicans are trying to shut down almost all public health programs, believing that the private sector will do better. Is the situation in Britain similar?
First of all, let’s say that NHS is loved in the UK, and this is true for every citizen of the country. This is part of our national identity, our values. Health is very important for people (education and economy too, but health is first and foremost), and that’s why citizens are interested in its maintenance – and, accordingly, politicians.
It seems to me that politicians understand the value of NHS for people and culture. Of course, there will always be disputes. People look at the health system through the prism of their ideology and views when they try to find a solution to the problems I was talking about, but I think that there is no real threat to the system. Of course, everyone wants to improve and modernize it.
Do you think Americans should follow the path to a comprehensive public health system? On the other hand, maybe the UK also has something to learn from America?
As far as I can see, the U.S. has truly fantastic health care providers and excellent private clinics. Many of our specialists are interested in working with American providers, who are developing new treatments. And I think that there are very interesting examples in the USA. For example, they have contracts with local therapists, which allow them to provide not only their services, but also the services of clinics – this is called Health maintenance organization. These things change the way the British look at our healthcare system.
But, as I said earlier, an analysis of global health care systems conducted by the Commonwealth Foundation has shown that the American system has problems in terms of accessibility and cost-effectiveness. Health care in the United States is the most expensive in the developed world, if we count the costs per citizen. Perhaps, they should think about whether this is the most cost-effective way. But it is up to the Americans, of course.
Tell us about the advantages of the health care systems of other countries, which have some practices that the British one lacks.
In general, I think that there are many good examples in the world. By the way, we have a scientific and innovative system aimed at international cooperation, in which we are trying to build ties between Britain and other countries, because we are interested in getting new knowledge from them, as they are from us.
For example, in India there are very interesting hospitals specializing in cardiac surgery, doing their job very effectively, and we think that we have something to learn here. If we talk about the system as a whole, I think we should look at the Scandinavian countries, which are extremely successful in this field. Germany and France are also good examples, but in Scandinavia the public health system is similar to ours, but at the same time very interesting innovations are being introduced there.
By the way, why do you think healthcare is a platform for such fierce disputes between the left and the right? In my opinion, the idea of abandoning universal health care looks simply stupid.
As I said before, health is the most important thing that a citizen cares about, and politicians have to take it into account. And, of course, they pass everything through the prism of their ideology.
But these are common words, and American Republicans, if you look at the root, just do not want the poor to have access to health services! Many of them cannot pay for insurance.
I think it all depends on your ideology and how you feel about the state as a whole.
Some will say that it is right to take money from citizens through taxation and direct these funds to help these same people (and all states do so to some extent). Others do not like a strong state and state distribution of resources, but are attracted by the idea that the market (or some other structure) helps people meet their needs. It’s all about what you believe in.
It’s also a question of whether it’s worth allocating a lot of money to the public health system (and it comes out), relying on the market to solve everything, or using a mixed approach. This is a rather philosophical question.
If we talk about public campaigns – what should they be like? After all, if you just write on the poster “Quit smoking”, it will not affect anyone.
It should be a combination of public policy and health services. For example, the UK legally banned smoking in public places a few years ago, this decision immediately affected the number of smokers in the country and very soon – the cancer rate.
At the same time, people should be helped to quit smoking, because smoking is an addiction. NHS has a service that helps people to do this. And we know that smokers not only temporarily quit, but also in general stop smoking four times more often with our help. We have made this service available to the public, and it has also helped to reduce the number of smokers in the country.
You spoke about the importance of decent wages for health care workers. How do you think the healthcare system in our big country should be built from this point of view?
Of course, I can only talk about Great Britain: we have a national grid of wage rates, and we take into account the difference between the regions of the country. For example, in London, the staff receives additional payments, because life in London is more expensive. In other words, we take into account the economy of this or that region, although we have a national grid of salaries.
In addition, it should be understood that even staff who are paid less can be helped in other ways – for example, by training and supporting them in other ways. In addition, an important practice is remote maintenance, diagnostics, surveillance, even remote operations using robotic manipulators! All this can be used to help less qualified employees.
In general, I think you need to think about how you can support these professionals not only with money, but also with technology and training.