Cubans tell NHS the secret of £7 a head healthcare Special report: the future of the NHS Sarah Boseley, health correspondent Monday October 2, 2000 The NHS is turning to Cuba for inspiration on how to improve its services. Officials from the Department of Heath and 100 GPs visited the Caribbean island which, despite being short of medicines and money after decades of a US-led economic embargo, manages to deliver excellent healthcare at a fraction of our cost. Later this month a delegation of Cuban doctors, led by Cuba's deputy health minister, will arrive in Britain to share the secrets of their success. The interest in Cuba comes at a time when the Labour government is intent on radical reforms of the NHS to make it patient-centred and more cost-effective. Cuba has a stunning record in both regards, with patient representation at every level, helping to organise the way the health service is run. The health secretary, Alan Milburn, has repeatedly said he wants to see GPs take a leading role in the reform of the NHS, and it is the quality, dedication and large numbers of family doctors in Cuba that have contributed most to its impressive health record. When Fidel Castro came to power, Cuba's mortality rates matched many other places in the developing world, with a life expectancy of 48 for men and 54 for women. Now it rivals anywhere in Europe or the US. Male life expectancy is 74 - the same as in the UK. Women can expect to live to 76 years old (79 in the UK) and infant mortality is 7.1 per 100,000 births - not much higher than ours. However, one major difference between Cuba's health statistics and ours has caught the attention of officials: here, healthcare costs £750 a head annually. In Cuba it costs £7. Among those who went on the Cuban trip earlier this year were the principal medical officer of the Department of Health, Phillip Leach, the eminent academic Sir Brian Jarman and the president of the Royal College of GPs, Sir Dennis Pereira Gray. Patrick Pietroni, a dean of postgraduate general practice at London University, who led the visit, said: "What we can learn is how they have managed to produce these healthcare statistics which are sometimes better than ours at 1% of the expenditure. They have more family doctors, who are better trained than our GPs. "When we went to Cuba what was so impressive were the three-storey buildings called consultorio. The ground floor was the practice, the first floor was the doctor's flat and the second floor was the nurse's flat. No Cuban lives more than 20 minutes or so from one of these." They also have fewer patients. Cuba has 30,000 GPs, the same number as Britain, but has only a fifth of the population. There is one family doctor per 500 to 700 people in Cuba, compared to one for 1,800 to 2,000 here. Cuba has 21 medical schools, but Britain has only 12. Cuba has 37,000 practice nurses. The UK, which has a shortage of all nurses, has just 10,300. Some of the good health of the Cuban nation is, paradoxically, the product of adversity. Food is rationed and meat is scarce, so much of the diet is fruit and vegetables. Because there is relatively little public or private transport, most people walk or cycle everywhere. Immunisation is compulsory and thanks to the interest and investment the state is prepared to make in health, Cuba has a vaccine for meningitis B, which is now being investigated in the UK - although the prevalent strains in Cuba are not the same as here. But despite the success insiders say many Cuban doctors use the opportunities they have in travelling to conferences to make contacts and leave Cuba for more money and better career prospects abroad.
