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Daniel Hannan is brazenly going on the offensive to continue his attack on the NHS.
Brave man. I think my money's on Prezza.
But do Hannan's facts stack up? He sounds awfully confident, as usual. So let's take a closer look.
1. Does Britain have the worst health outcomes in the west?
Hannan: "the NHS produces some of the worst health outcomes in the industrialised world. Britain is the Western state where you'd least want to have cancer or a stroke or heart disease". He's pretty confident!
Hannan's evidence? A link to a right-wing think-tank with the misleading name "Progressive Vision", founded 18 months ago by a couple of communications professionals and which "is beginning more detailed research in this area" which it already knows will show why Singapore's health outcomes could be replicated in Britain if we ditched the NHS. Interesting methodology. (Lancet and BMJ papers are mentioned, but no references are cited). (Indeed, Progressive Vision's website rather suggests it may be seeking to test the old canard that a buzzy think-tank does not really need any research or publications to back up press releases and media advocacy. It has sections on "views", "media releases" and "media coverage" but no "publications" nor "research". Perhaps they will get round to some, but then perhaps they won't).
Fact check: But shall we perhaps also check against something cited and peer reviewed? Choose your weapon, Mr Hannan. We shall make this a home fixture for your Fox News friends by deploying The Journal of the American Medical Association. This 2006 article looks rather relevant. The authors are a pretty credible crew, from University College London and Institute for Fiscal Studies (Dr Banks), Department of Epidemiology, University College London (Dr Marmot) and Institute for Fiscal Studies (Ms Oldfield), London, England; and RAND Corp, Santa Monica, Calif (Dr Smith). I think it is reasonable to regard Professor Marmot as trumps in the international health evidence field.
So is Dan Hannan right? Sadly, they conclude exactly the opposite. (Perhaps Hannan would offer us his critique of their evidence?)
US residents are much less healthy than their English counterparts and these differences exist at all points of the SES distribution ... The US population in late middle age is less healthy than the equivalent British population for diabetes, hypertension, heart disease, myocardial infarction, stroke, lung disease, and cancer ... These differences are not solely driven by the bottom of the SES distribution. In many diseases, the top of the SES distribution is less healthy in the United States as well.
And it gets more interesting than that.
With the sole exception of cancer, there exists a sharp negative gradient across both education and income groups in both countries ... As a result, country differences are larger and tend to be more statistically different at the bottom of the social hierarchy than at the top. Level differences between countries are sufficiently large that individuals in the top of the education and income strata in the United States have comparable rates of diabetes and heart disease as those in the bottom of the income and education strata in England."
Given that we are factual Fabian types, looking for the evidence rather than just promoting our own prejudices like Mr Hannan, let me note that there is also some evidence from the US which the NHS should learn from. There has been a lot of interest within the NHS since 2002 of studies in the BMJ of how the Kaiser Permanente model in California provides very good outcomes for the resources put in, particularly because of its model of integrated and preventive care.
This evidence was used in Dr Howard Stoate's Challenging the Citadel to call for a shift to a much more preventive health system, much less focused on acute care. Breaking public and political focus on the District General Hospital model is one key to this. Populist local campaigning to save every hospital may be tempting, but it is a barrier to using health resources more effectively. Conservative party please note!
Chris Ham summarises some of that evidence in this Nuffield Trust paper on Clinically Integrated Systems (pages 9-10). That this is not incompatible with the principles of the NHS can be seen impressive innovation lessons come from the public, socialised and successful part of US healthcare: the Veterans Health Administration. This must create a bit of cognitive dissonance at Fox News: Veterans (v.good); public socialised healthcare (v.bad). But the evidence shows that even the US might be able to develop patriotic pride in collective health provision after all! Indeed, my favourite US health wonk, Ezra Klein, produced a useful survey of the health of nations for the American Prospect in 2007. He isn't massively sold on the UK system, compared to that in France: what he could say for the NHS was that it offers universal coverage and better health outcomes than the US system while spending 41% per capita of what Americans spend. Though the cumulative funding gap between UK and leading European systems over the last three decades has been enormous, though the last decade has narrowed (but not eliminated) that gap.
2. Public opposition to the NHS
Hannan: "Outside Westminster, the old incantations are losing their magic. ... Yes, all three parties are committed to the NHS ... I wonder whether, as on tax and borrowing, public opinion hasn't overtaken the Westminster consensus".
Hannan's evidence? Who knows. Hunch? Unique ability of the right-wing populist to intuit beliefs of the British people? Talking to his ex-colleagues on the Telegraph leader writing desk?
Fact check: Who is right? Dan Hannan or John Prescott. Hmm ... Tricky. I know: what about asking people what they think? It turns out that YouGov have done exactly that. Hurrah!
OK, they were commissioned by the pesky fact-finding Fabian Society, but they did poll 3000 people. And the options put were a pretty fair way to find out whether Hannan's idle musings are shared by people in the real world. Look, we even gave people the "full Hannan" - terrible mistake for 60 years - as well as the "gradualist Hannan" of getting rid of the NHS by stealth.
The NHS is sixty years old this year. Which of the following best describes your attitude to it?
(a) Whatever problems the NHS may have, its commitment to free treatment for everyone means it is still one of our great national symbols: 70%
(b) The NHS was a good idea for its time but we now need a different way of running modern healthcare provision: 25%
(c) The NHS was a bad idea from the start and it should be abolished and replaced with something different: 1%
(d) Don't know: 3%
Labour voters were 80-15-1-4.
Conservative voters were 56-39-3-2.
LibDems were 79-13-3-5.
So Dan Hannan is wrong again. But there is some pressure within the Tory party and, more weakly, among Tory voters for rethinking and even scrapping the NHS.
Is the NHS safe in their hands? Not if Hannan gets his way. He notes that he is a humble backbench MEP, but he is developing quite a profile as the hero of the grassroots and has been given a keynote slot at the Spring conference to rally the troops.
While Michael Howard quickly sacked Howard Flight, David Cameron hasn't even asked Mr Hannan to stop shouting his mouth off about why the NHS should be scrapped a few weeks before he tops the Tory candidates list in a national election. And what does it tell us about the modern Conservative party that a candidate who rejects the party's policy of staying in the European Union, and rejects the party's professed support for the NHS gets to be top of his regional list for the European elections?
My view of progressive Conservatism has been that it would be nice if it were true. The evidence is increasingly strong that the Tory party doesn't agree with that.
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