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Last Updated: Thursday, 2 December, 2004, 15:20 GMT
US analyst awards NHS top marks
Doctor with elderly patient
The NHS is given top marks in the report
The NHS is set to be the world's best healthcare system - according to a US health expert.

Professor Donald Berwick of the Institute for Healthcare Improvement made the claim in the journal Quality in Safety and Healthcare.

Compared with the US, he said the UK had done more to improve measures such as safety and effectiveness.

But a spokesman for the King's Fund, an independent think-tank, said Professor Berwick's analysis was "superficial".

This seems to be a little superficial in its analysis of the NHS
John Appleby, King's Fund
In his analysis, Professor Berwick said the US and UK healthcare systems faced similar problems, including improving safety and reducing medical errors, making care more effective and efficient, ensuring care focuses on patients rather than diseases or numbers, reducing waits, and offering everyone the same access to treatment.

But he said that, if asked to bet on which country will succeed in resolving them, "my money will be on the UK".

His verdict came in advance of the latest report of the NHS's performance from its chief executive Sir Nigel Crisp, due out on Friday.

'A behemoth system'

Professor Berwick praised the Labour government, and Prime Minister Tony Blair in particular, for the recent NHS Modernisation Plan - which saw the percentage of GDP spent on the health service rise from 6.5% to closer to the EU average of 8.5% - and the introduction of National Service Frameworks.

He wrote: "The modernisation process sought to establish accountabilities, structures, resources and schedules in the NHS that no-one at all is in a position to establish in the pluralistic, chaotic, leaderless US system."

However, he admitted that this rosy vision was not universally shared.

"No-one is thoroughly happy in the UK with the NHS modernisation programme to date; it has stumbled occasionally, as any project of that level of ambition must.

"But no honest observer can fail to credit the process with immense productive change, headed for real measurable success in a behemoth system that could easily seem unchangeable."

He said the biggest difference between the UK and US was "simple".

"The UK has people in charge of its health care - people with the clear duty and much of the authority to take on the challenge of changing the system as a whole."

"When it comes to health care as a nation, the US is leaderless," he said.


But Professor Berwick said there were three key areas in which the NHS had to improve.

He said the UK healthcare system was too fragmented, he says, with acute care and primary care providers still appearing to distrust each other and often working in different, and uncomplementary, ways.

Professor Berwick also said the doctor-patient relationship was un-balanced, with patients "trained too well" to defer to the clinician. He said the service needed to be far more patient-centred.

The training and education of health professionals also needed to be altered to encourage clinicians to accept change, he said.

John Appleby, chief economist at the King's Fund, said: "This article seems to be a little superficial in its analysis of the NHS."

He said the commentary was not based on hard facts, and a World Health Organization evaluation of healthcare systems in 2000 placed France top - and the UK 18th.

Mr Appleby added: "It's true that the NHS does have a leader, but that doesn't mean it is a given that the right policies in place.

"There are potential problems with a couple of the main government policies of patient choice and a new way of paying hospitals, which both carry considerable risks and which aren't certain to give a better NHS for everybody."

And Shadow Health Secretary Andrew Lansley said: "Dr Berwick┐s report is at odds with reality: spending on hospitals has increased by almost 28% but activity has increased by only 5%."

He added: "One million people are still on waiting lists and 5,000 people die from hospital superbugs every year

But Dr Michael Dixon. chairman of the NHS Alliance, said: "This analysis is absolutely spot-on. It is refreshing to hear it."

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