Close to our hearts

Health care is a principle of enormous importance to a healthy society, and providing health care to all, free at the point of delivery, is enshrined in our National Health Service. A continuing desire to uphold that principle is something that is close to the heart of the nation.

However, developed nations around the world are now struggling to balance the opportunity for a world-class health-care service offered by medical, scientific and technological advances with the economic challenges that are inherent if such a service is offered to all.

By the end of this decade, NHS spending is expected to approach 10 per cent of UK GDP (0.3 per cent of world GDP, over £100bn, or over £4,500 per household). Public finances are so weakened that the International Monetary Fund (IMF) is warning that NHS reform must be a priority for any new government. Reform is certainly crucial if the NHS is to provide a service characterised by greater choice and enhanced care.

At the Royal College of General Practitioners (RCGP) annual national primary care conference in Glasgow this month, the RCGP president, Professor David Haslam, called for a greater focus on GPs and primary care as the solution to the ills of the NHS.

He said: "For far too long the focus in health care has been on hospitals. High-quality primary care can prevent illness but there is no story in that. There is no drama in something not happening. But as a patient I know which one I would prefer . . . General practice is by far the largest of all the medical specialties. We are in the part of the medical world that is going to be the future."

A recent review by the 2009 Commonwealth Fund International Health Policy Survey compared primary care services in 11 countries: Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the UK and the US. Researchers concluded that services provided by GPs in the UK stand out from those in other countries for "information capacity, a systemic approach to chronic care, and incentives to support improved performance". The UK performed well on measures of access to treatments, care for chronic conditions, out-of-hours access to services and the degree to which electronic medical records were used, they said.

However, the researchers also suggested that policymakers could learn from studying the approaches taken in different countries. In recent times, attention has been on the US, as President Barack Obama seeks to deliver on the promises made in his election campaign. America's programme of health reform has been eagerly followed in the UK, particularly after unfavourable comparisons were drawn between the NHS and the US health-care system during the summer of 2009.

The New Statesman and Pfizer Policy Forum round table that begins on page 6 provides a platform for constructive debate on this issue, with participants looking at the shared challenges facing the UK and US health systems and their areas of relative strength or weakness.

On page 4, Niall Dickson, chief executive of the King's Fund, sets the scene for the debate by assessing the challenges currently facing the NHS.