Analysis Personal paper

A transatlantic review of the NHS at 60

BMJ 2008; 337 doi: http://dx.doi.org/10.1136/bmj.a838 (Published 17 July 2008) Cite this as: BMJ 2008;337:a838
  1. Donald M Berwick, president
  1. 1Institute for Healthcare Improvement, 20 University Road, 7th Floor, Cambridge, MA 02138, USA
  1. dberwick{at}ihi.org

    At the NHS Live conference celebrating 60 years of the NHS at the beginning of July, Donald Berwick explained why he admires the UK health system and how it could be even better

    Cynics beware, I am romantic about the National Health Service; I love it. All I need to do to rediscover the romance is to look at health care in my own country.

    The NHS is one of the astounding human endeavours of modern times. Because you use a nation as the scale and taxation as the funding, the NHS is highly political. It is a stage for the polarising debates of modern social theory: debates between market theorists and social planning; enlightenment science and post-modern sceptics of science; utilitarianism and individualism; the premise that we are all responsible for each other and the premise that we are each responsible for ourselves; those for whom government is a source of hope and those for whom government is hopeless. But, even in these debates, you are unified by your nation’s promise to make health care a human right.

    No one in their right mind would expect that to be easy. No wonder that, even at age 60, the NHS seems still immature, adolescent, searching.

    You could have chosen an easier route. My nation did. It’s easier in the United States because we do not promise health care as a human right. In America, people ask, “How can health care be a human right? We can’t afford it.” As a result, almost 50 million Americans, one in seven, do not have health insurance. Here, you make it harder for yourselves, because you don’t make that excuse. You cap your healthcare budget, and you make the political and economic choices you need to make to keep affordability within reach. And, you …

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