Thursday, April 05, 2007

Another incredibly busy few weeks, making it almost impossible to keep up the blog (Hurray, you shout). I need to go back to the 19th of March to pick up where I left of.
I was in Brussels to speak at the annual
European Voice conference. I’ve spoken at it before and it’s always a good opportunity to catch up with what is happening. My task was to contribute to a panel entitled “Can Europe’s health systems survive?” Actually, it was a fairly silly question. After all, we have tried to do without health systems before – it involves stepping over dead bodies in the streets and it’s really not very nice. However I guessed that the organisers wanted a rather more nuanced response. Perhaps we could rephrase the question to say what do Europe’s health systems need to do to adapt to future challenge? In fact we can be quite optimistic. Health systems have changed continually in the face of changing patterns of disease, changing expectations, and changing opportunities. Just think if what happened in the 1950s when, in industrialised countries, polio was being eradicated and tuberculosis was coming under control. Orthopaedic surgeons were running out of work as, until then, they had been kept busy with tendon transplants on children with paralytic polio and drainage of tuberculous spinal abscesses. So they invented the hip replacement, and then the knee and shoulder replacements. Chest surgeons lacking tuberculous lung cavities to operate on moved into heart surgery. There has been an enormous shift of care from hospital to primary care as changes in technology have challenged the basis for many of the services provided in the acute hospital. In other words, we will always have challenges to confront but there is no reason why they should defeat us. In fact, this was the broad consensus, which was a pleasant surprise because there is usually someone who is predicting loudly the end of the welfare state as we know it, summoning visions of catastrophe as we are overwhelmed by aging populations as our jobs disappear to the far east or some other low wage economy. It is certainly true that we need to respond to an aging population but the situation is much less worrying than it seems. First, people require a lot of resources not because they are old but because they are about to die. Just because 75 year olds cost a lot to look after it does not follow that 75 year olds will cost the same in the future. The highest costs are in the last year of life and there is even evidence that these fall if you die at an older age because you are treated less intensively.
Then there are worries that there will not be enough people in work to pay for those who are retired. Only if we keep the retirement age as it is. There is no good reason to do so (honest). A very small change would actually compensate for the predicted changes in longevity far into the future. And anyway, there is good evidence that compression of morbidity is really happening. In other words, while people are living longer, they are living even longer in good health. Yes, we do need to reconfigure health care delivery, to take account of the increased numbers surviving with multiple chronic diseases, but that can be done. It just requires a clear vision and some political will (ok, there’s not a lot of either about). All in all, Europe’s health systems can survive. They just need to adapt. That they can do, but only if they are allowed to by our political masters. Perhaps they are the greatest threat, predicting doom and then by their actions making sure it comes about. In the UK a favoured term in 10 Downing Street is “creative destruction” – the idea that if you push the public sector far beyond its limit something new and good will emerge. I can’t help feeling they are wrong, but if they are it will soon be too late to do anything about it.

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