This Government, like the last, considers that competition and choice are the ways to improve quality and efficiency in the National Health Service. It believes that the market, along with a massive structural shake-up and yet more bureaucracy busting, is the best way forward for the future of the NHS.
Yet one of the most successful healthcare systems in the world has no competition, no market and no involvement of large for-profit multinational private companies.Cuba’s health standards are legendary and now a British doctor has made a documentary film showing how, for a very modest outlay, Cuba manages to have a publicly funded and run national health service.
Like Britain’s, it is based on the primary care family doctor system. In fact, Fidel Castro used our NHS as an example when he set it up. But while our NHS has been subjected to continued radical reorganisations and creeping privatisation, the Cuban one has remained true to its founding principles. This is why it is so successful. Scarce resources are concentrated on patient care not squandered on market-driven reforms.
Professor Michael Tynan, a children’s heart specialist at Guy’s Hospital in London until he retired from the NHS, first went to Cuba in 1986 to help to set up a children’s heart programme. He has returned virtually every year since to advise and assist the ever-expanding service. He made a documentary, The Doctors’ Revolution, to show other medics how, in a country with a developing world economy, life expectancy is as high as in any Western country and infant mortality is lower. It paints a fascinating picture from the hundreds of consultorios, a type of polyclinic where family doctors and nurses are based, to the high-tech hospitals with state-of-the-art facilities for the most complex surgery. All are run by the state and are free for all Cuban citizens and available even in the most remote corners of the island.
The film includes an interview with Fidel Castro, carried out before he became ill in 2006, in which he talks about his pride in one of his greatest achievements – free healthcare for all. He boasts about how Cuba altruistically sends medical teams to under-developed countries in need and disaster zones throughout the world. “It is no use sending aid if the country hasn’t got the doctors to help people, which is why we send the doctors and nurses”, he explains.
For every Cuban, all doctors’ visits, medications and treatments are paid for by the state. Not only is all healthcare free, so is medical education. Students get free tuition, free books and free board and lodging, even a small allowance. This probably explains why Cuba has such a large number of doctors.
Despite the economic embargo, hundreds of students from the United States, unable to pay the exorbitant fees in their own country, go to study for free at Cuba’s “Latin America” medical school. The way university fees are going up here, we could soon see an exodus of English medical students in the same way.
Before the revolution in 1959, Cuba had only 6,000 doctors, many of whom went abroad. Now there is the same number of GPs as in Britain, yet Cuba has only a fifth of the population. Each family doctor has between 300 and 400 patients, compared to more than 1500 for most GPs in England. Every person lives within 15 to 20 minutes of their local consultorio, which provides most of the care a patient is likely to need and makes seeking medical help easy and getting a diagnosis and treatment speedy. Minor operations and outpatient appointments with specialists can all be offered at the consultorio. The hospitals provide first-class care with no waiting lists and have become expert in many sophisticated procedures. Havana Eye Hospital carries out 90 operations a day and has its own eye bank for corneal grafts.
Cuba is the only country in the world with a nationwide programme offering heart scans for all babies in the womb as part of routine prenatal care. Its scientists developed a vaccine against meningococcal meningitis type B. They have eliminated polio, TB, typhoid fever and diphtheria.
Tragically, the collapse of the Soviet Union added to the American blockade, has left Cuba short of medicines, instruments and equipment. A procedure to correct a young boy’s heart that Michael Tynan could easily have performed in Britain using keyhole surgery was impossible because the correct-sized equipment was manufactured in the US and so unavailable in Cuba. Instead the child had to undergo far riskier open-heart surgery and a longer stay in hospital.
Nevertheless, the Cuban health service shows that high-quality health care for all can be provided without massive financial investment. Ironically, some of the good health of the Cuban people is the product of enforced adversity. Food is rationed and scarce so their diet consists mainly of fruit and vegetables and all meals are freshly prepared. There are no fast food outlets or packaged fat and sugar-laden ready meals. There is relatively little public or private transport, so most people walk or cycle everywhere.
Even though the English NHS has achieved impressive advances, the health of millions continues to deteriorate. We still don’t have equitable healthcare for all. There is still a postcode lottery for many drugs and operations. But the worst culprit responsible for our poor health has to be our unhealthy lifestyles, eating the wrong foods, exercising too little and drinking alcohol too much. Tragically, no health service – even one run as efficiently as Cuba’s – is going to be able to rectify that.
In Cuba everyone has a job – albeit a low paid one – and everyone has a decent home. The education system, like the healthcare system, is excellent. If that was the situation here, everyone’s physical and mental wellbeing would improve and so would lifestyles.
