Oh NHS, thou art sick

The NHS's main problem may be overpoliticisation

Papers p 135

It seems to be universally agreed that the NHS is sick. It is plagued by delay, low quality care, and poor outcomes.1 The chancellor of the exchequer has called for a great debate on the service,2 which must include exploring the causes of the sickness and possible treatments. Ideally the debate will be informed by evidence, and the BMJ today publishes a study that is an important contribution (p 135).3 It is a broad brush comparison between the NHS and Kaiser Permanente, a health maintenance organisation that cares for some 6.1 million Californians. The study finds that the two systems have similar resources but that Kaiser performs substantially better. In particular, patients from Kaiser have faster access to both primary and secondary care doctors. In other words, the widely held idea that the NHS—albeit cheap—is remarkably efficient may be wrong.

Comparisons between systems are always difficult, and readers will rightly be sceptical, not least because they challenge a belief that is widely and deeply held in Britain. Our reviewers and editorial team started from that position but concluded that the results could not be explained by artefacts in the study or differences …