Is UK on course for best healthcare system in the world?
The UK is well on the way to having the best healthcare system in the world, surpassing that of the US, says leading health strategist, Dr Donald Berwick of the US Institute of Healthcare Improvement
. But the UK has to first grapple with three difficult issues, and soon, he warns in Quality and Safety in Health Care, if it is to make good on its efforts to date. Both the US and the UK are "strikingly similar" in the problems they face in improving their respective healthcare systems, writes Dr Berwick. But if asked to bet on which country will succeed in resolving them, "my money will be on the UK," he declares. "The biggest reason is simple," he writes. "The UK has people in charge of its health care - people with the clear duty and much of the authority to take on the challenge of changing the system as a whole." "When it comes to health care as a nation, the US is leaderless," he says, describing the US healthcare system as "pluralistic, chaotic, leaderless." The "key resource" for the NHS, he says, "has been the consistent focus of government, emanating from the Prime Minister personally, on raising the bar for NHS performance." While acknowledging that happiness is not legion in the NHS, Dr Berwick says that the inevitable stumbles on the path to reform bear testimony to the enormity of the ambition. "No honest observer can fail to credit the process with immense productive change, headed for real measurable successes, in a behemoth system that could easily seem unchangeable," he opines. But he continues: "Three tough issues lie between the good successes that are almost in hand and the great ones that could be." For one, the UK healthcare system is still too fragmented, he says, with acute care and primary care providers distrustful of each other and frequently working within different systems of planning, action, and patient care. Secondly, British patients are still far too passive, and British clinicians "habitually more controlling" than is good for either party, he suggests. Patient centred care is more than a political agenda, he writes, research shows that it is better for the health of patients, he says. Thirdly, current training and education of health professionals falls far short of the qualities required to foster and nourish change. He cites systems thinking, statistics, measurement, cooperation, group process, teamwork and "pragmatic 'real time science'" among the list of key but absent disciplines. "The omission is costly now, and will be more costly in the future, as the workforce continues to be ill prepared to cope with - let alone to lead - a new evidence based, reliable, patient centred, efficient, and safe system of care," he contends.