Last week I did a live broadcast for Radio Wales, to publicise my book.  The first question I was asked was – after 65 years, how does the NHS stand up compared to other countries? Is it fit for purpose for the future?

What a question. It would take another book to answer this question fully!

I answered that, yes, the NHS is fit for purpose, up to standard compared to other countries, especially America. It provides healthcare equitably for everyone.

The interviewer was not impressed. What about France? She said. They don’t have to wait for operations or to see specialists there and their care is excellent!

That was a problem to answer. It is easy to compare the NHS positively to America, where people go untreated, go bankrupt getting medical care and where public health and health safety statistics are awful. France is generally considered to provide excellent coverage and their waits for hospital treatment are short, with plenty of choice for patients. They spend much more than we do but seem to get value for money.

But wait. Are we comparing like with like?

Take a visit to a GP. You would pay (after state re-imbursement) £5 every time unless you were very poor or very sick. You would still wait several weeks for routine appointments, or several hours in the surgery if you thought you needed to be seen as an emergency. GP’s are poorly paid and have to see a lot of patients in order to make a living. You will have a choice of very good hospitals, but will have to pay a surcharge, (20% for the first month) and most people have additional insurance to cover these costs. You will also have to pay a proportion of the costs of an ambulance. Emergency waits can be quite long (though actually that is true almost everywhere).

So patients have to cough up money to get the type of service we get in the NHS. Would we in the UK be prepared to pay? Would my interviewer be prepared to pay?

Many people do in fact pay privately in the UK for a better or quicker service. In my area over 25% of referrals in some specialities were to private consultants. The difference between the NHS and all other European countries that I know of is that if you pay privately you will then be outside the NHS for everything, while in other European countries all patients are entitled to, and expected to get, additional coverage on top of what the state provides. The state provision therefore often entails long waits, just as in the NHS, though the quality when you get to hospital should be high.

The other difference is that in the UK only specialists who are already working for the NHS see private patients, unlike in France where any specialist with the relevant training can set up shop. It is virtually unheard of for someone who is not a respected consultant to see private patients in the UK. The main result of this is that therefore there are fewer specialists in the UK overall, although of course they are all of very high calibre. But this introduces shortages, and also perverse incentives for consultants not to worry too much about NHS waiting lists as this will increase their private practice.

So I stand by my view that the NHS stands up well when compared to other European countries. The statistics (OECD) on public health indices (child mortality etc) are excellent and cancer survival though not in the top league, has improved recently because of the recent increase in funding up to 2012, and is now pretty good.

So would people in the UK prefer to add more of their own money, when they see shortfalls in treatment here?

No, they prefer, and the media prefer, to bash the NHS. They can do that, as it is still one system, in Wales, at any rate and in England at the moment, though that may change. On the continent people grumble about their coverage, the charges, the hospital staff, the GP, but not the system, which they know is designed to make sure that every one gets adequate healthcare. And the media doesn’t have anything to bash unless something goes very wrong.

Well I couldn’t say all that in a 2-minute slot of course.

I stand by my answer, because I support the NHS and want people to understand the realities of what is good evidence-based healthcare.

I did say, which is the truth, that France now has a huge problem servicing their health care system as they are in austerity just like us. The French population is very dependent on drugs and treatment fixes and every visit to a GP gets a prescription, most of which are not needed. Their system seems to have produced a nation of hypochondriacs even more than ours!

If you want more on this topic there is loads of stuff on this topic in my book

“A sceptical GP” by Elen Samuel, available on Kindle (Amazon USA and Europe) for £2.43

The print edition is available from the publishers – Rheafield Publishing (email  macfieh@mac-rhea.co.uk), or bookshops throughout Wales at £11.99 (469 pages) +p&p.