According to Saturday’s Times, the government’s new ‘five-year plan’ for the future of NHS cancer services (due to be released today) admits for the first time that the UK has poor survival rates compared with Western Europe, the US and Canada. Long waiting lists for radiotherapy and chemotherapy, as well as rationing which means too few sessions of treatment are given, are at the heart of the problem.
Money isn’t the issue here. Since 2000 the government has tripled spending on cancer, and the UK no longer lags behind Europe or North America on this front. The problem is structural. As Karol Sikova, the former head of the cancer programme at the World Health Organisation, told The Times, most of the extra money lavished on the health service has gone towards the salaries of people who don’t work with patients:
We have funded mangers to deal with targets while in France, Germany and Italy that bureaucracy just does not exist.
Unfortunately, the government’s approach to improving cancer services does not appear to have taken this on board – doctors are simply being ordered to increase radiotherapy doses and, no doubt, there will be new targets for waiting times, and more mangers to make sure the targets are met.
The government’s addiction to targets is understandable, and, I think, based in a genuine desire to improve customer service. In the absence of competition and market forces to drive up standards, targets and regulation are the obvious option. Trouble is, they just don’t work and have significant unintended consequences.
The only way to really improve the National Health Service (assuming its continued existence) is to create the freest and most extensive internal market possible. That probably means breaking the NHS up into smaller, more localized commissioning units which would fund patients (at a set treatment price) to go to the doctor or hospital of their choice (whether state or private), as well as the introduction of a capped co-payments scheme for treatment (like those that exist elsewhere in Europe).
Sadly, the government is not still not prepared to think that radically.