DAVID GROSSMAN: The Conservatives long journey
to the next election is beginning with a little trip. Dr Liam Fox the Shadow
Health Secretary is today visiting Germany, a country with hospitals so
efficient the only trolleys in the corridors are moving and enquiries about
waiting lists meet with blank incomprehension. In this happy land of medical
plenty the Tories are looking for a Health policy.
DANIEL FINKELSTEIN: The Conservative Party's looking
all around Europe at solutions that other countries are using successfully
to blend private finance with public finance.
ANDREW LANSLEY MP: The NHS is not being sustained
at the moment at an adequate standard, in a sense the issue is not should
the NHS change or not? It must change.
GROSSMAN: If the NHS was ever the
envy of the world they certainly seem to have overcome their jealousy in
places like Berlin. The Conservatives think that the way they deliver healthcare
here, particularly the mixture of public and private provision could have
important lessons for the UK, and for their chances of assembling a set
of policies on public services that the electorate will take to.
It's not hard to see why the Tories are looking to Europe for clues on
how to improve the NHS. In the treatment of many diseases patients are
significantly better off than they are in the UK. With prostate cancer
for example, sixty-seven point six per cent of patients in Germany survive
at least five years after diagnosis. In France the rate is only slightly
less at sixty-one point seven per cent. But within the UK England has
the worst survival rate, way down at forty-four point three per cent.
With Leukemia too, five year survival rates in Germany are thirty-nine
per cent, in France forty-four point nine per cent with England lagging
well behind at twenty-seven point nine per cent.
RUTH LEA: I think the first thing
if you look at different types of cancers then the survival rates tend
to be much poorer and poorer in this country than they do on the Continent,
but I think where you really see the difference is in things like waiting
times and waiting lists. If you talk to doctors in Germany or in France
they just don't understand the concept of a waiting time, here we understand
it only too well and I think that's where the biggest problems are.
GROSSMAN: The Think Tank Civitas
hosts a seminar on Health. Until recently the German system was a bit like
German cuisine, largely ignored overseas. It's recipe with a greater
role for the private sector is essentially unchanged since Bismarck's
day, but is now very definitely in vogue. The message from Professor Friedrich
Breyer of the University of Konstanz is that it's a system based on choice
and autonomy, with the state, companies and individuals all contributing
to achieve results that can leave the NHS standing.
PROFESSOR FRIEDRICH BREYER: I wouldn't call the NHS the envy of
the world, because the way patients are treated in this system is more
favourable in most European countries. We have free choice of physicians,
we have practically no waiting lists.
GROSSMAN: Undoubtedly, one reason
why they're able to achieve significantly better results on the Continent
is that their health systems are far better funded. The proportion of the
country's earnings spent on publicly funded healthcare in Germany is seven-point-nine
per cent, in France it's seven-point-three per cent, whereas in Britain
it's just five-point-six per cent. The funding gap doesn't end there -
when you add the amount of private money spent in each country the total
in Germany becomes ten-point-six per cent, in France nine-point-six per
cent and in Britain just six-point-seven per cent.
LEA: I think it's absolutely
vital that you get more money into a healthcare system, clearly we do pay
less as a percentage of GDP than they do on the Continent, certainly in
France and Germany, and I think the biggest shortfall here is actually
on the private sector rather than the public sector, although we fall down
on the public sector as well. I think the key thing is, yes we can see
that Gordon Brown's going to put more taxpayer funded money in, but with
changes to healthcare, you've got demographic changes, you've got technology
changes, you've got changing expectations, at the end of the day I think
people will have to be incentivised to spend more of their own money on
healthcare if we're really going to get up to the standards of the Continent.
LANSLEY; I'm sure it will be the
case in the long run that publicly funded healthcare is part of a mix and
people who are able to make a contribution do make a contribution to it,
probably primarily through employer-funded health insurance packages.
GROSSMAN: Dr Liam Fox makes a house
call. Inside Berlin GP Dr Roland Krasser's surgery it's modern and well-equipped.
In Britain The Prime Minister has this week re-committed Labour to pushing
NHS spending up the EU average within four years. But any new money it
seems must come from general taxation. That could leave the Tories clear
to propose more private finance.
Coming to Europe and looking for ideas about how to reorganise the NHS
is one thing. Taking those ideas back to the UK and trying to convince
a sceptical British public is another matter altogether. Some Conservatives
fear that however attractive the idea of putting more private sector involvement
in the Health Service might be to them it's just the sort of policy that
could terrify an already hostile British electorate.
FINKELSTEIN: I think that the problem of
involving private finance, involving private organisations in the National
Health Service, in having some measure of mix between public and private
insurance, has not, is not the scary concept that it was five years ago,
partly because the Labour Party has talked so much about these things.
Nevertheless, behind all those things lie severe dangers that people will
worry that something they value, free NHS at the point of use, might be
being endangered, so the Party's got to come up with radical interesting
ideas that can make a real difference while at the same time reassuring
people that it won't change the things that they value the most and that's
a very difficult combination, it's not impossible but it's difficult.
GROSSMAN: Andrew Lansley and Liam
Fox struggle to lift Tory gloom during the last election campaign. Then
their message on Health concentrated on Labour's failings, definitely not
proposing radical Tory solutions.
LANSLEY: I think the world has
moved on, I think the experience of the last four years has said to the
British public that Labour didn't have the answers that they thought they
did in 1997 and I think the public now are more open-minded about the changes
that are going to be needed in the future in order to provide healthcare,
and I think that may therefore give the Conservative Party a considerable
GROSSMAN: But are voters really
any more receptive to new ideas now? On the Record commissioned some research
to see how such policies might go down with voters. We asked: If the Conservatives
proposed that a higher proportion of healthcare be paid for by private
insurance, would you approve? Thirty-one per cent did, whilst fifty-seven
per cent disapproved. We also asked: If the Tories proposed that some treatments
currently provided for free by the NHS should in future be paid for privately
by patients, only nineteen per cent thought it was a good idea whilst seventy-two
per cent didn't like the idea. Finally, and perhaps more encouragingly
for the Tories when we asked if the Conservatives proposed making private
hospitals play a bigger part within the NHS, fifty-three per cent approved
whilst thirty-six pr cent disapproved of the idea.
FINKELSTEIN: The Conservative Party knows
that radical solutions are necessary, it doesn't believe that the current
system could be managed as it is, but on the other hand, if you propose
radical alternatives you immediately run into the problem that people may
distrust those solutions and particularly if they're advanced by a Conservative
Party they don't traditionally associate with caring about the NHS, so
it's a big opportunity, but it's also a big problem.
GROSSMAN: It's back to the airport
for the Tory health team for the flight home. Having lots of ideas from
abroad will certainly help - they're off to Stockholm tonight to give the
Swedish system a check up. The real test though is turning all these air
miles into a workable prescription for the NHS and getting UK voters to