Health care in Europe shames the NHS; is there really nothing to learn?

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Analysis: Tax-funded or privately financed? The political balancing act

"Vote Conservative to save the NHS" may be, for the moment, fantasy politics, but at least the Conservatives are trying. Despite the fears of what remains of the "one-nation" wing of the party, Iain Duncan Smith's leadership has not been one long rant about the euro. Instead, he has visited deprived areas of Britain and delivered thoughtful speeches about poverty and the state of our schools and hospitals. The Tory health spokesman, Dr Liam Fox, has been similarly assiduous, touring Europe to learn about different systems of health care. In that context, yesterday's Conservative Policy Unit paper – "Alternative prescriptions, a survey of international healthcare systems" – is another welcome sign that the Tories are open-minded about reforming the National Health Service.

For it is axiomatic that, as Mr Duncan Smith says in the foreword to the document, "the problems of the NHS are not just a matter of money. It is the system that is failing". Indeed, there is evidence to suggest that the NHS is incapable of sensibly spending even the 7 per cent annual increase in funding that it has received recently.

To see the sort of dramatic change in the quality of NHS provision that matches the rhetoric on all sides about a "world-class service", there has to be a dramatic shift in the balance of power towards the patient. Only by ensuring that cash follows them through choices, exercised inside or outside the NHS, can there be any hope of such a radical improvement.

Despite the 10-year plans, the targets and the exhortatory speeches by ministers, the structures of the NHS remain deeply unfriendly to the interests of the patient. Alan Milburn, the Secretary of State for Health, and his colleagues appear well aware of that but seem unwilling to take on the vested interests. If the pre-Budget spin is to be believed, they will try to make the NHS work through piecemeal, modest reforms linked to a vast infusion of money.

That approach may work in the short term, but returning to the taxpayer time and again cannot be an option for the long run. Tax rates, as New Labour used to say, have to be set at levels that do not destroy competitiveness; they must also be acceptable to a sceptical electorate.

This is why it is so short-sighted of the Government to insist that we have nothing to learn from the experience of other countries. Backed by the findings of the Wanless report, ministers say that we have the most equitable system of funding for health care; yet the World Health Organisation (WHO) places us only seventh in the league table of developed economies for the "fairness" of the way we fund the NHS. We lie 17th for the responsiveness of our system, rating poorly for "respecting the dignity of the individual". An NHS that is only slightly less fair in the way it is funded but that can treat many more patients quickly and relieve much more suffering is surely worth thinking about.

Why not learn from abroad? Why not look at the German system of social insurance, judged fairer by the WHO than our tax-based approach? Why not examine the Dutch tradition of independent hospitals, which stimulates competition? Why not a larger role for the private sector, smaller in Britain than most other developed countries?

The NHS is not the envy of the world, if it ever was, and we will not make it so until we drop our chauvinism and admit that other countries do things differently – and sometimes better.