NHS: Money alone will not cure the ills

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How stylishly the French do things. Walking through the entrance of the 837-bed Georges Pompidou hospital in Paris, you enter a huge space filled with light. The quarter-mile-long "main street", under glass, is a humming thoroughfare where people come to shop, chat or sit under the ornamental trees.

There are no traditional wards – every patient has a single room in this public hospital. Remote-controlled trolleys deliver gourmet meals and a state-of-the-art "suitcase" system, oddly reminiscent of the vacuum tubes that carried cash and receipts round department stores in the 1950s, takes blood samples from the patient's bedside to the laboratory, tests and returns them – all automatically.

The Georges Pompidou is the flagship of the French health system, demonstrating what you can get for high investment sustained over decades. The French spend 9.5 per cent of GDP on their health service, compared with 6.7 per cent in Britain.

Is more money all that the NHS needs? It would help, certainly. But one or two years of generous awards from the Chancellor, Gordon Brown, will not do the trick. It takes five, 10 or 15 years to train doctors, build hospitals and develop medical services.

We began slipping behind our European neighbours 20 years ago. Between 1980 and 1985 spending on the French health service grew at an astonishing 13.6 per cent a year. In the second half of the 1980s the annual growth rate slowed to 7.6 per cent and only in 1993 were the brakes put on to bring the figure down closer to 4 per cent.

In Britain, the average real growth in the National Health Service between 2000-01 and 2003-04 is running at little more than 6 per cent – and that is the highest it has been in the health service's 53-year history.

So the NHS we have now, with its gloomy corridors and long queues, is the one we sowed a generation ago, just as the foundation of the French service, with its gleaming hospitals and care on demand, was laid in the 1970s and 1980s.

Money, however, is not all it takes. To see this you need only travel north of the border. Scotland spends about a quarter more on its health service than we do in England – £1,059 a head compared with £885 – a level roughly on a par with the European Union average.

So we have on our doorstep a model of what the NHS could look like in three years' time if spending is steadily increased to lift it to the EU average as Tony Blair pledged on the BBC television programme Breakfast with Frost two years ago.

So how does it look? The picture is not all rosy. Certainly, as Rudolf Klein observed in The Independent last month, Scotland has more doctors, more nurses and more beds and can treat patients at a more leisurely pace. Scottish GPs have smaller lists of patients and hand out more prescriptions.

However, there is not much difference in waiting times and while the Scots get more of some things, such as hip replacements, they get fewer of others, such as cataract removals. The Scots are also more likely to go to hospital and once there, stay longer. It is unclear whether this is because their patients are more ill – or because when the beds are there they tend to get filled.

More money alone will therefore not do the trick. There must be reform of the way care is delivered, too. Ministers in the UK are determined to transform the NHS from a service that is provider-dominated to one that is consumer-driven. But there are dangers here, too.

The French service's greatest selling point is that the patients are in the driving seat. They can select their doctor or specialist and go where they choose for care (with up to 70 per cent of the cost reimbursed by the state and the remainder covered by private insurance). They believe in technology and if there is a treatment available they want it. The system is highly popular with patients.

The downside is that there is no monitoring of doctors' or hospitals' safety, and patients are ripe for exploitation. Drug spending is rocketing and care is inequitably distributed. Worse, despite recent efforts to curb spending, the health budget is spiralling out of control.

The challenge for ministers in Britain is how to preserve the efficiency and equity of the NHS with the freedom of choice of the French system. Two priorities should be: delivering more care outside hospitals in the community, where it is cheaper, more convenient and more efficient; and introducing competition in delivery, perhaps by encouraging private-sector involvement, to increase choice.