Debate about NHS reform has been intense in 2013 as the service has entered its historic 65th year and the need for greater accountability has become apparent in response to lapses in care such as those at Mid Staffordshire.
In light of this, it is important to learn from what is already established practice abroad and one of the best examples is Sweden, a nation with a word-class healthcare system with a history and ethos closely comparable with our own revered health service. It was developed after the war by a reforming social democratic government, it is financed from general taxation, it is universally accessible and it was traditionally provided by the state. On closer inspection, however, there are significant differences in both design and performance which may be instructive for the UK.
As I detail in a new report for the think tank Civitas, health outcomes in Sweden are consistently far better than in Britain on most measures – this includes amenable mortality, which to some extent measures deaths preventable by the health system itself. Sweden performs better in international rankings and satisfaction surveys and polls there often give the system high ratings.
Crucially, rather than being a single centralised ‘National Health Service’, the system is run by elected county and municipal governments and is funded from local taxes, keeping services responsive and accountable. Central government provides extensive oversight and a quarter of health funding, providing critical state-local balance and a sense that the system is national. Localism fosters a stronger sense of ownership and engagement, making citizens willing to pay for better services
As in the NHS, market reforms have been brought in to enhance patient choice and drive up standards – these have intensified since 2006. There is early evidence that in some areas, reform has improved accessibility, productivity and satisfaction. The reforms have also brought non-profit organisations back into healthcare and to some extent enjoy consensus political support. Localism has also aided reform, allowing communities to go at their own pace and learn from each other’s experiences.
All in all, there is much we can learn from Sweden. Its progress with market reforms, sometimes said to be an inspiration for the UK coalition’s current NHS agenda, is worth watching closely. But while competition tends to be an ideological dividing line in British health policy debates, a replication of Sweden’s long-standing, admirable and carefully-structured commitment to localism could potentially be a far easier point for consensus in the UK.
The main Westminster parties are already committed to some form of health localism. The Liberal Democrats pledged in 2010 to put new “elected Local Health Boards” in charge of commissioning, the coalition has pursued localism by putting commissioning in hands of GP-led Clinical Commissioning Groups and Labour are discussing putting council-run Health & Wellbeing Boards in charge of joint health and social care commissioning.
Since there is already something of a cross-party agreement on the merits of localism, Sweden offers a powerful case study for how we can successfully bring about such a system and radically devolve power to communities and patients in the UK.
* Elliot Bidgood is research fellow in health reform for the think tank Civitas.