The case for change in NHS 'over-sold'
- 28 January 2011
- From the section Health
The government has over-sold the need for its overhaul of the NHS in England, a leading health economist suggests.
One of the key arguments put forward by ministers was that England was lagging behind in terms of the number of deaths from certain diseases.
But Professor John Appleby, of the King's Fund think-tank, said such comparisons were "not straightforward".
The government rejected the criticism, saying it was the right thing to focus on improving health.
It is handing control of much of the NHS budget to GPs in the coming years. This move will also lead to the abolition of primary care trusts and strategic health authorities.
Health Secretary Andrew Lansley has said the changes are needed to make the NHS more responsive to patients.
But he has also based the proposals on the fact that outcomes in England - the numbers dying early from disease and how long they are surviving - lag behind other European countries.
But Professor Appleby, writing in the British Medical Journal, said the government's approach revealed "only part of the story".
One of the areas which ministers have focused on is heart disease, but Professor Appleby said the UK had had the largest fall in heart attack deaths between 1980 and 2006 of any European country.
If the trends continued, the UK will have a lower death rate than France - one of Europe's top performers - as soon as 2012, Professor Appleby said.
A second focus of the government is cancer deaths.
But Professor Appleby said it depends on what cancer statistics are focused on.
He said death rates for lung cancer in men, for instance, rose steadily to a peak in the UK in 1979 and have been declining ever since, whereas in France it happened much later.
Meanwhile, breast cancer deaths in the UK have fallen by 40% over the last two decades to virtually close the gap with France. Again, if trends continue, it is likely that the UK will have lower death rates in just a few years.
Professor Appleby said such measures needed to be "approached with caution" as they were often down to lifestyle factors as well as the quality of healthcare.
But he added: "These trends must challenge one of the government's key justifications for reforming the NHS."
However, health minister Lord Howe said: "There is a wealth of research which demonstrates beyond doubt that UK health outcomes are relatively worse than they could be.
"Our proposals will put the NHS on a more sustainable footing for the future, empower clinicians to design services in the best interests of patients and ensure it is comparable to the world's best-performing health systems."