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Observer Comment Extra

How can the NHS match Europe's best?

Is the most important issue underfunding - or are cultural and organisational issues equally important? What are the most important lessons to learn - and what are the areas where the NHS outperforms the rest of Europe? The Observer asked leading health experts and commentators for their views.

'In my view the major factor for the NHS is not underfunding as such but under-resourcing. That is to say a shortage of skilled staff, particularly doctors, and a sustained lack of capital investment over past years. The doctor shortage is exacerbated by a particular problem for Britain: the prevalence of private practice. The perverse incentives that encourage consultants to pursue private practice at the expense of their public commitments must be addressed.'
- Julian Le Grand, Richard Titmuss Professor of Social Policy, LSE

'It is fashionable to assert that the NHS does worse than other European countries but comparisons between health care systems are based on unreliable indices of performance. The NHS is relatively efficient - we spend less per head than most equivalent OECD countries, with similar health outcomes. As with most countries, we do not derive as much benefit as we could from available health resources - the quality of care and communication between professionals and patients and their carers needs to be further improved.

However, spending more on health care does not automatically improve health. This is more efficiently achieved by investment in effective public health measures, the early years of life, education, better quality of working lives, and reducing levels of poverty.'
- Professor Trevor Sheldon, Head of Department of Health Sciences, University of York

'The main aim of health policy should be to ensure access for everyone, regardless of income or wealth. But the government does not need to own and run all the hospitals, employ every clinician, and pay for the whole lot through taxes to achieve this end. Social insurance schemes, like those in Germany or Switzerland, allow ordinary people to see more clearly the connection between the cost and the standard of service they receive, enabling them to make a better judgment about how much ought to be spent. Moreover, hospitals and doctors are able to manage their affairs with greater autonomy, permitting consumers to escape bad service and facilitating a competitive search for improvement. Without independent hospitals and social insurance, the NHS will always be a national embarrassment.'
- David Green, Director, Civitas

'Of course the biggest limitation on UK health performance is underfunding. Happily this is now being addressed but politicians and the public need to understand that it will take years for the full benefits to be felt. According to Nobel prize-winning economic historian Robert W Fogel, health outcomes in the US improved steadily through the Great Depression, despite massive unemployment, because of hospital investments over the previous sixty years. Let's also not forget the social context - we all know that the biggest determinant of poor health is poverty and, as Richard Wilkinson's work has shown, the very experience of inequality. Britain has some of the worst poverty and inequality in Europe. Nevertheless we are leading the way in bringing down deaths from cancer and coronary heart disease through preventative measures. For the most part the NHS deserves its popularity; it's the "inputs" that we need to keep in view.'
- Martin McIvor, Director, Catalyst