How to run a health service

It has been said that celebrity newspaper columnist Simon Jenkins is wrong about everything, to which I would add that this is a sure fire route to success in opinion journalism. Actually, to be fair, Jenkins is wrong about virtually everything.

On this week’s edition of BBC Radio 4’s Any Questions, Jenkins contributed to a tangential discussion about the National Health Service in England, and made an intelligent bordering on politically profound point, marred only by a small but significant factual error.

In contrast to England’s centrally managed NHS, the health service in Denmark is run at regional level, with the five administrative regions having replaced 15 counties which existed prior to 2007. The counties varied in population size from 43,000 on the Baltic island of Bornholm, to 660,000 in Århus. Today, the regions are home to between 600,000 and a million and a half.

Local government in Denmark is based mostly on the municipality, with larger-scale infrastructure managed at regional level. The latter includes healthcare provision, and from my own experience, and wider knowledge of Danish society, I would say that the system functions much better than does the behemoth which is the NHS in England. This is the point that Jenkins made in the Any Questions discussion. Jenkins’ mistake was to base his argument on the situation prior to 2007, when it was the Danish counties that provided healthcare services.

The reason why the Danish health service works so well, compared with more centralised systems, is the existence of efficient communication channels within the administration, and the ability of the component clinical sections to respond dynamically to real-time need. There is no country-wide corporate body overseeing the health system, though the regional health boards are of course accountable to the national interior and health ministry.

During the Any Questions discussion, Liberty director Shami Chakrabarti came out with an uncharacteristically hysterical retort to Jenkins’ praise for the Danish system, and questioned how one could possibly manage heart surgery on a parish council level. That was a very silly thing to say, and quite beneath the normally sober-headed champion of British civil liberties.

In Denmark, health service administration is centred on the regions, but there are open channels of communication and resource sharing between them. There is supposed to be a similar internal market within the English NHS, yet often we hear of communication failures in and squabbling between local health trusts, with service provision in certain clinical sectors being something of a postcode lottery. That does not happen in Denmark, or at least not to anything like the same degree as it does in England.

What it comes down to is this: in Denmark they do management, whereas in England we do managerialism. There is a difference.