Cancer survival rates in Britain are too low. We need an insurance-based NHS
A diagnosis of cancer is no longer a death sentence. It is a national scandal, however, that the outcome is more likely to be terminal here in Britain than in most other comparable countries. British medical research often leads the world, yet the National Health Service is failing to match survival rates elsewhere. Why can’t we keep up?
A large-scale survey published in The Lancet Oncology, based on data from four million cancer patients between 1995 and 2013, reveals that Britain lags behind Australia, Canada, Denmark, Ireland, New Zealand and Norway. In most of the cancers included, the gap is substantial. In Canada, 21.7 per cent of lung cancer patients were still alive after five years; here, just 14.7 per cent. In Australia, 70.8 per cent of colon cancer patients survived; in the UK, the figure was 58.9 per cent. The figures for rectal cancer were similar. For pancreatic cancer, the British survival rate was half that of Australia; for stomach cancer, less than two-thirds. Only in ovarian and oesophageal cancer did Britain avoid bottom place among the countries surveyed.
What explains such disparities? The NHS naturally blames underfunding. It is true that the technology it uses is often old and in short supply: Britain is absurdly short of scanning equipment per capita compared to other rich countries, for example. The Institute of Cancer Research (itself a world-class institution) blames a shortage of specialist staff, such as nurses trained in chemotherapy.
The underlying causes are deeper, however. Though the NHS has screening programmes for breast and bowel cancer, most cancers continue to be diagnosed too late. In 20 per cent of cases, they are only detected during emergency procedures — in other words, by chance. Even when GPs do refer patients for urgent treatment, 94 out of 131 cancer services in England missed their target of treating them within 62 days in 85 per cent of cases. The NHS has tried to blame its poor showing in the Lancet survey on out of date figures, but these are for 2018-19 and they are much worse than five years ago. Given that half of all people will get cancer at some point in their lives, leading to a quarter of all deaths, this failure to treat patients quickly is simply not good enough.
What is to be done? The fundamental reason why the NHS performs badly has a great deal to do with the reason why the British love it: it is “free at the point of delivery”. In other words, it is paid for by taxes rather than insurance, unlike all the other countries with better outcomes. A tax-funded system is inherently political, hence inflexible and unresponsive to demand. So the UK devotes fewer resources to health than its competitors, yet we are surprised that we also have worse outcomes.
Politics also explains why there is a lack of support for moving to an insurance system to pay for the NHS. No party dares to propose such a reform. But the public is quite capable of embracing change if it is properly explained and there are incentives to do so. In this case, a public information campaign offering a cheap, simple and carefully regulated health insurance system, with tax rebates for those who switch over to it, could quickly become popular. Employers would be incentivised, and the larger ones obliged, to offer insurance schemes to their staff. For young people, the incentive might be a remission of student fees. The aim would be to move over to an insurance system for the majority of the population within a decade, with the existing system continuing alongside it for a dwindling number of older and poorer patients.
Once the British discover the advantages of an insurance-funded NHS, they will shed some of their inhibitions about using the service properly. At present, 34 per cent of NHS patients fear “wasting the doctor’s time”. Others actually do treat their GPs in a cavalier way, perhaps because they see health care as “free”. Both phenomena are likely to diminish once patients are paying for their care through insurance.
Whether Matt Hancock will commission research into such a funding model, as a prelude to legislation, is doubtful. He is seen as a technocrat rather than a reformer. But Boris Johnson is nothing if not bold. If he can secure a majority in the inevitable post-Brexit shakeup, there will never be a better time to grasp the NHS nettle. He could even point out that moving to a “Continental” insurance system proves that, for him at least, Brexit does not mean being allergic to all things European.
In any case, the priority should be the thousands of cancer patients and others who die unnecessarily every year because the NHS has failed them. They, and indeed the whole country, deserve better.
