Friday, January 18, 2008

A new TaxPayers' Alliance report - Wasting Lives: A statistical analysis of NHS performance in European context since 1981

A report I have written, Wasting Lives: A statistical analysis of NHS performance in European context since 1981, examining NHS performance and putting it in context with an examination of trends in Europe was released today. It has done rather well in the media and will hopefully provide a new clarity to the healthcare debate - illustrating both the huge stakes and the failure of recent strategy.

The empirical method used, mortality amenable to healthcare, was obviously inspired by Nolte & McKee's 2003 study of amenable mortality, which was cited in the Better Government position paper (PDF). However, the analysis was inspired by this graph, and others like it, from the Department of Health (PDF):

Look at the pattern for England compared to the EU-15. Premature mortality from circulatory diseases is definitely falling - and converging on the EU-15 average. But its been falling pretty steadily since the eighties. If you look at that graph its very hard to spot what has happened to massive additional spending since 1999.

Replacing this graph of one condition with no filtering for conditions amenable to healthcare with the aggregate mortality amenable to healthcare numbers in our study was an enormous empirical task. It required exporting the numbers for a given gender, in a given country, in a given year from the raw World Health Organisation database to a spreadsheet. That spreadsheet filtered for conditions amenable to healthcare and then turned those numbers into an age-standardised rate. This had to be done for each gender, each year and each country. It was a big process but it gave us an aggregate measure of healthcare progress in Britain and the European countries studied.

We could then look and find out two things. First, we could get an estimate of the human cost each year of the poor performance of the NHS. These are mortality rates and it is easy to lose sight of the fact that they represent a staggering number of lives lost. Innumerable tragedies, a significant number of which, over 17,000 by our estimate, could have been avoided if we matched the performance of European healthcare systems.

Second, we can see whether massive increases in funding post-1999 have had been effective. It appears they haven't. There is no discernable effect of the additional funding in the mortality numbers. If we want to get the kind of performance in healthcare that people in Europe expect and receive we need to learn lessons from how they organise healthcare: we need to decentralise, encourage competition and end political management.

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