Healthcare sans frontières

Over the past few decades, Britain has lost illusions that it was "the best in the world" at many things, including a certain sport that is about to begin its quadrennial international tournament in South Africa. The national religion known as the National Health Service is still capable of resuscitating this assumption. The idea that healthcare will be free at the point of delivery remains a hugely powerful idea, and Britons reasonably take pride that it produces fairer and often better results at far less cost than the expensive and hole ridden patchwork of a health insurance system found in the US. Meanwhile, the wide range of systems used in Europe are generally ignored, despite many examples of excellence. Perhaps as a result of these structural differences, there seems to be little interest in ideas for healthcare innovation from other countries (although there are honourable exceptions among NHS staff). Information on medical and pharmaceutical research is shared and discussed internationally; not doing the same for other healthcare processes seems short sighted. To take the US, some providers have good ideas, despite the country's overall problems. Kaiser Permanente lets patients email their doctors through a secure webmail system, then guarantees they will get a reply in 48 hours (less in some specialities - see article ). It has found that in some cases emails remove the need for physical appointments. As Kaiser is an integrated healthcare provider, with staff paid a salary rather than for each activity – like the NHS – this makes financial sense, as well as providing patients with a more convenient option. England and Scotland already have a secure webmail system in the shape of NHSmail, although it is used only by staff. Why not try extending it to patients? It looks like an efficiency measure that could improve service to patients at the same time. Meanwhile, Britain is already involved in Epsos, an international pilot programme designed to share very limited emergency patient medical data between EU countries, which looks set to turn into a standardised system for sending emergency medical data around Europe during this decade. NHS Connecting for Health is contributing expertise in quality control, but will not be hosting a pilot ( see article ). The coalition government combines the Conservatives' scepticism towards Europe with the Lib Dems' enthusiasm, and it can combine both attitudes in deciding Britain's future involvement with Epsos. On the friendly side, the UK should be entirely open to joining the programme and its successor projects. Many Britons live abroad – there are about 1m who live in Spain either full-time or for more than three months of each year, according to 2006 figures from IPPR – with many moving for retirement, making access to emergency health records more significant. And many Europeans come to Britain to look for work, so the NHS could offer them better emergency care (and possibly do it more efficiently) with access to records. On the sceptic side, why limit such a scheme to Europe? There are, similarly, hundreds of thousands of Britons living in Commonwealth countries including Canada and Australia, often with reciprocal healthcare arrangements, while the UK hosts many of their citizens. There is a similar situation with the US, even if not on the financial side. Britain could help extend a European style scheme to the rest of the world. The NHS is a great British institution. Allowing good ideas and projects to transfer and extend across borders can only make it greater.