Looking For A Cure

Britain’s Labour Party came to power in 1997 pledging to “save” the country’s decrepit and over-stretched National Health Service. The once-vaunted system of taxpayer-funded health care for all, founded by the postwar Labour government in 1948, had degenerated into a chaotic, inefficient monolith as the burdens on it increased and its resources diminished. Then, in January 2000, a flu outbreak exposed exactly how sick the NHS really was. Thousands of flu victims jammed doctors’ offices and hospital emergency rooms; routine operations like hip replacements and cataract removals had to be canceled to make beds available for the acutely ill. Newspapers groaned with reports of patients abandoned in hospital corridors because there was nowhere else to put them. An estimated 20,000, mainly elderly, people died. David Cummings, a retired food technologist, now 74, fell ill with food poisoning at the height of the crisis. Nurses initially tucked him up in crisp white sheets on a ward in Princess Margaret Hospital in Swindon, about 100 km west of London. Three hours later, they turfed him out and onto a trolley in a corridor. “I stayed on that trolley for three nights,” he says, adding with typical British understatement: “It wasn’t at all comfortable.”

It wasn’t at all comfortable for the government of Prime Minister Tony Blair either, which faced a daily avalanche of gruesome headlines, public outrage and blame for having failed to fix the system. At the time, Britain spent only 6.8% of its GDP on health care, compared to a European Union average of nearly 9%. Apart from the flu outbreak, there were record numbers of patients waiting for simple procedures to treat varicose veins and hemorrhoids, while mortality rates for heart disease and cancer were among the highest in the developed world.

Blair prescribed a raft of changes — more doctors and nurses, shorter waits for treatment, new hospitals and an all-out attack on killer diseases — and promised to raise Britain’s health-care spending to the E.U. average by 2006. “It was almost a no-brainer,” says Blair’s former health adviser Simon Stevens, now president of health-care firm UnitedHealth Europe. “For a left-of-center administration, the answer was always going to be to increase spending with reforms.”

In its campaign for a third term, Labour has made the NHS a key component of its re-election bid, promising to maintain higher spending, further reduce waiting lists, offer patients a choice of hospitals and shift up to 15% of care to the private sector. The NHS is at the top of voters’ concerns, and the legacies of Blair and Labour will be judged just as much on whether they succeed in revitalizing the NHS as on their decision to go to war in Iraq or their management of the economy. So, has Labour delivered on its promise to save the NHS?

The statistics look good. Britain will this year spend 8.5% of GDP on health care, a figure set to reach 9.2% in two years. The NHS’s annual budget has doubled to $170 billion since 1997. Tens of thousands of new doctors and nurses have been hired. Crumbling prewar facilities have been replaced, in part thanks to injections of private finance into the system. Access to treatment for cancer and heart disease has improved, as have survival rates. In England, where five out of six Britons live, the number of people waiting for treatments like knee surgery and hysterectomies has fallen sharply, though opponents say the figures are fudged. The verdict from Jennifer Dixon, director of policy at the King’s Fund, a health-policy think tank in London: “On the whole, [Labour] has achieved what it set out to achieve.”

Yet, there are still recurring complaints. Centrally imposed government targets have reduced waits, but have also distorted priorities by encouraging hospitals to first treat patients who have waited longest, sometimes disregarding the seriousness of their ailments. The Conservatives’ health spokesman, Andrew Lansley, promises, “On the first day of a Conservative government, we will abolish all political targets imposed on the NHS.” NHS staffers now number 1.3 million, Europe’s largest workforce, but the system is still short of radiologists, surgeons and clinical psychologists. And for some patients, the cure has proved worse than the disease — an estimated 9% of inpatients acquire infections while in England’s hospitals; some 5,000 people die every year as a result. The rate of infection by methicillin-resistant staphylococcus aureus (MRSA), a bacterial infection that doesn’t respond to conventional antibiotics, is among Europe’s highest — an estimated 955 deaths last year were attributed to MRSA. “We’re in a state of disbelief that hospitals may kill us not because of illness, but because they’re dirty,” says Vanessa Bourne of the Patients Association, a consumer group. “Patients can’t understand why this isn’t top of the priority list.”

The risk of MRSA is “absolutely something I weigh up in admitting an elderly patient to hospital,” says Sam Everington, a physician in the deprived east London neighborhood of Bromley-by-Bow. Since the elderly are especially vulnerable, “I would say: ‘Look, part of me wants to admit you to hospital, but the risks are very great and I can treat you at home with high doses of antibiotics.'” Tony Field, 65, a retired financial adviser, learned about those risks the hard way. He contracted MRSA through bedsores while awaiting an operation in a Birmingham hospital five years ago. “The hospital was absolutely rife with MRSA,” he says. “As a result, I’ve lost the whole of one thighbone.”

Losses to the NHS are also crippling. The National Audit Office estimated five years ago that hospital-acquired infections cost the NHS as much as $1.9 billion a year in prolonged hospitalizations, and that 15% of cases could have been prevented simply by ensuring better hygiene. The issue has generated heat in an election campaign where the three main parties are competing to outdo each others’ promises of largesse for the NHS.

The Conservatives say they will increase health spending by $65 billion a year but would spend much of that money in subsidies to patients who opt for private treatment. The Liberal Democrats advocate tax rises to fund health checks and better personal care services for the elderly and disabled. Labour is wooing voters with still shorter waiting lists and, by 2008, the pick of any hospital for their operations. The delivery of all these grand plans depends on the continuing health of the British economy, of course, and on the ability of the NHS to put any additional resources to good use.

On the ground, some patients already report improvements. Cummings, evicted unceremoniously from his hospital bed during the flu crisis five years ago, also remembers waiting up to a month to see his local physician. Now, a new practice has opened near his home. “It’s a vast improvement,” he says. “It’s newer. It’s modern. They’ve got a younger team of doctors. By and large, you can get to see a doctor within a week.” The reason: Labour has given the NHS enough money to hire 27,000 more doctors and 79,000 more nurses since 1997, offering higher pay, flexible hours and child-care facilities.

The country’s health-care infrastructure is improving, too, albeit slowly. Four years ago, Bedford Hospital, 100 km north of London, became a symbol of decline when the door of a temporary mortuary, brought in because the main one was often full, couldn’t be opened. Corpses were instead laid out beneath sheets in the hospital’s chapel. Images of the makeshift morgue provoked public outrage, and the episode helped prompt a policy shift toward giving hospitals greater responsibility for day-to-day operations. “Nobody wants to have a crisis,” says Bedford’s chief executive, Andrew Reed, who joined after the mortuary scandal. “But if you do have a crisis, it means everybody wants change and it makes the process of implementing change easier.”

Bedford has since built new cardiac and ear, nose and throat departments, a new cancer unit, and a $13 million pathology building, and added 56 new beds, 60 additional nurses and 12 new specialist doctors. Last year, it earned three stars, the maximum possible, in the Healthcare Commission’s performance ratings, up from zero in 2002. Patients even gave its food top grades.

Customer satisfaction is high across the NHS, according to a survey of patients who used its services last year: three out of four rated their personal care as excellent or very good. Yet when the public is polled, they are more likely to be critical, consistently registering dissatisfaction with the system as a whole. The fact is, the NHS has got better faster than the public’s perception of it. While the government struggles to persuade voters to recognize its achievements with the NHS, many refuse to applaud. In a face-the-public TV session last week, an audience member argued with Blair that his 48-hour target for seeing a GP made things worse because doctors refused to accept appointments made more than two days in advance. Blair later admitted that some targets were “too crude.”

The task of making the NHS more efficient and responsive is still monumental, and the funding that’s made recent progress possible won’t go on rising forever. Though he’s more satisfied with his local health service, David Cummings seeks private care when he needs a specialist. “Yes, the NHS is improving,” he says, “but we still have a long way to go.”