Should UK's healthcare system aim to be more like Sweden's?

The view from above of a laptop, on a desk. It is surrounded by screwed up balls of paper, and a stethoscope rests partially across the keyboard.

writer icon Jeff Standen     ISB   |   Tech     🕐 07. Jan. 2019

The British National Health Service (NHS) is seen by many as a treasured institution. While UK healthcare is at the forefront of medical research and practice, the actual organisation and administration of the NHS appears to be falling behind the times, at least in terms of modern tech equipment.

In May 2017, many hospital cyber systems were affected by a ransomware attack which caused problems with out-patient appointments and cancellation of surgical procedures. Although not specifically aimed at NHS, the cyber-attack was successful where tech equipment had not been updated.

Out-dated equipment

In December 2018, following a freedom of information request by the Royal College of Surgeons, it was discovered that the NHS was still using fax machines. Such machines have been largely superseded by digital methods and the NHS Trusts have been instructed from central government level to stop using them.

In a way, this will force the NHS to upgrade from fax machines to digital messaging, but local managers of NHS Trusts are already under immense financial pressures.

For some time, there has been a move towards a central computerised system for the NHS. However, after considerable development, a final contract for the supply of such a system has yet to be confirmed. In September 2013 the project was temporarily abandoned due to spiralling costs, estimated then to be beyond £10 billion

The structure of the NHS provides for a number of local healthcare trusts, each one being quasi-autonomous but accountable to central government. At primary healthcare level, there are still some paper-based record systems. Individual trusts may have their own local, online systems.

International placing

Overall standards of healthcare are set and sampled by the Care Quality Commission (CQC) which produces reports and rankings for public information. Internationally, the UK is ranked 23. Norway (2), Sweden (8), and Denmark (17) are all ranked higher. 

In Sweden, healthcare management is devolved regionally with county councils having responsibility for healthcare. While there is no central computerised system, there is a National eHealth Policy, aimed at making better use of IT and access to patient records across county boundaries. There is no equivalent to this in the UK.

Cultural differences

In practice, there are some counties where equipment and practices are still catching up. Sweden has a National Patient Survey which, while similar to the British CQC, has a greater reliance on patient perspective. The CQC is descriptive and critical, whereas Sweden's National eHealth does appear to be informative and pragmatic.

Perhaps the fact that Swedes are culturally happier to pay higher taxes may be a decisive influence on the higher Swedish ranking, if it is suggested that more proportionally more funding per capita is available for healthcare. In the UK, it is felt that not enough of the taxes go towards healthcare and while many Brits would not complain at a small tax increase to fund healthcare, there is some way to go before they would happily part with taxes at the Swedish level.

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