It is shocking to realise just how uncontrolled most healthcare systems are. You could call them supertankers with medievael navigation. The trouble is that this analogy suggests that there is a pilot at the wheel and that everyone is in a single craft.

In most countries it would be more correct to say that the bridge is crowded with dozens of people, all with very different ideas of which direction the system should move.

Why medievael? First, because data on the performance of these systems are poor and always out of date.  Secondly, because the pilots can’t agree on which data are the most important.  In any case, many of the pilots don’t really look at the data much at all.  They are more concerned with the winds of political change.

Five years on, and Healthcare Europa remains confused by the very idea of a “policymaker”. It implies someone who is rationally trying to come up with the best possible trajectory, based on the interpretation of facts and who has the power to then make policy.  In practice, individuals seem few and far between. You could lump in academics with policymakers, but most have no power over policy. And, in any case, their use and interpretation of data is selective and subjective.

But surely there are teams of civil servants in ministries dedicated to shaping and producing rational healthcare polices?

Frankly, we have yet to come across such individuals. Either they hide themselves away very carefully, or they do not really exist.

So, in many countries, there is simply a horde of individuals on the bridge, many representing professional or private interests, and all with different maps of where they want to take the ship.

In fact, if you were to ask them to describe the vessel in question, they would have very different notions of what the craft looked like. To some, she is a plastic pedelo; to others, a fleet of fishing trawlers; to others, a supertanker.

Part of the problem is a lack of clear information sources.  The fact that there are thousands of healthcare academics across Europe hinders rather than helps. Each is typically working on a small, provincial sector,  and they disagree with each other on many levels. Also, everything they produce is nearly free.  Yet, paradoxically, the fragmentation of academic information forces governments to turn to management consultancies for advice. This costs hundreds of millions in fees.

So the pilots pay other pilots to navigate them in a vessel – which may be a pedelo or may be a fishing fleet – towards destinations about which they can not agree.

Is it any wonder that healthcare reform is such a mess in every country?

Well, perhaps not every country. There are exceptions. Turkey, under the grip for over 10 years a of strong-willed minister of health, has steered a successful trajectory. So has the Netherlands, and, to a lesser extent, France, where there has been a consensus among the ruling elite. But these are the exceptions.  In Germany, there are so many pilots that the ship has stopped moving.  The UK could only be described as erratic. Indeed, many passengers think that this particular ship is sinking.

Doesn’t everyone know what we have just described? Most citizens would be shocked by a such a description. Many insiders would prefer to deny the reality. They prefer to present healthcare systems as measured, professional, well-run craft with GPS and a competent pilot. It is time to acknowledge that this is a lie, before we all end up on the rocks.