Any British tourist unfortunate enough to be admitted to hospital in Australia may be comforted by the familiar accents. Thousands of doctors and nurses have fled the NHS for a life down under, lured by better pay and working conditions and the prospect of year-round sunshine.
Like thousands of his compatriots, Wes Streeting, the health secretary, is enticed by the Australian healthcare system.
Streeting recently made a 20,000-mile round trip to the country, visiting GPs and hospitals in Melbourne, Sydney and Canberra. His fact-finding mission aimed to investigate how Australia achieves significantly better outcomes when tackling the biggest killers, including cancer, heart disease and strokes. It does this while costing the taxpayer less than the NHS, thanks to a hybrid private-public funding model.
What are the key lessons that Streeting will have learnt, and how could the new Labour government apply them?
Universal healthcare “topped up” with private insurance
Most Australians carry a small green card, a passport to universal healthcare, known as the Medicare card. It allows citizens and permanent residents to see a doctor free of charge or to be treated in hospital without a fee or for very little, a system akin to the NHS.
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Like the NHS, the Medicare system is funded by a levy on taxpayers, equating to 2 per cent of their income. High earners who do not have an appropriate level of private hospital insurance pay an extra Medicare surcharge of 1 per cent to 1.5 per cent, depending on their income. The tax incentives encourage Australians who can afford it to take out private health cover to reduce the burden on the public health system.
Huge private hospital network improves patient choice
More than half of the Australian population — about 13.6 million people — have private health insurance that allows them to select a doctor of their choosing to reduce their waiting time for non-urgent surgery, and to get a private hospital room.
In comparison, only 10 per cent of the UK population have private health insurance. Patients without private insurance who need non-urgent care, such as hip replacements, may have to wait longer for a public hospital bed.
The take-up of private health insurance is large in Australia because there is a big network of private hospitals. The healthcare system is serviced by about 800 public hospitals and 620 private hospitals.
Freedom from centralised diktats
One big difference is that there is less of a controlling hand from national politicians in Australia than in the UK. Under the NHS’s “top-heavy” model, local hospitals and GPs are directed by a central body, NHS England, which sets national targets and priorities and has an annual budget of £163 billion.
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By contrast, regional state governments in Australia are largely left to their own devices to tailor health systems to local needs. “A lot more power and trust lie in regions rather than nationally,” Siva Anandaciva, from the King’s Fund think tank, said. “In the Australian healthcare system the individual states have a much more powerful and formal role in managing services, with the federal [the UK equivalent of national] largely providing the funding and a limited set of nationally held programmes.”
Doctors have shorter days and better pay
Labour is adamant that striking junior doctors will not get a 35 per cent pay rise, so any deal to settle the long-running dispute is likely to revolve around improved working conditions.
Streeting will be able to look to Australia for inspiration: doctors report more flexible rotas, shorter days and more training opportunities — although Labour may struggle to magic better weather. Dr Phil Colwell, an emergency medical consultant who left the NHS in 2017 to move to Australia, said doctors were “flogged” in the NHS, whereas in Australia they had “space and time to actually learn”.
Colwell earns about A$500,000 (£260,000) a year, three times what he would make had he stayed in the UK. “Australian doctors in my hospital are completely outnumbered by overseas doctors,” Colwell said. “I have nine months of sunshine a year and can go outdoors and enjoy the beaches, swimming, surfing and hiking.”
Investment in scanners and technology
Australia has five times more scanners per person than the NHS, which means that patients get seen much more rapidly. Long NHS waiting lists — currently at 7.6 million — are being driven by a shortage of diagnostic equipment, such as CT and MRI scanners. The latest international comparisons of 19 western nations by the Organisation for Economic Co-operation and Development show that the UK has the lowest number of scanners.
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Australia is in third place, behind Japan and the United States. This investment in diagnostic scanners helps to explain why the UK lags behind Australia in cancer survival, because early diagnosis is crucial. Australia also has more hospital beds and intensive care beds than the UK.
Make GP hubs the ‘front door’ of healthcare
Streeting said that one of his takeaways from Australia was how they were “shifting the centre of gravity out towards community health centres”. The country is rolling out a new network of urgent care clinics that are open in the evenings and on weekends, taking pressure off A&E services.
Since taking up his role, Streeting has announced plans to divert billions from hospitals to GPs in a sign that he could follow this model. He is also keen to emulate Australia’s strong policies on prevention: it was the first country to ban disposable vapes, a policy that will be included in Labour’s first King’s Speech.
