Expert questions Lansley's key arguments for NHS reform

It has been claimed that despite spending the same on health care, we suffer twice the rate of deaths from heart disease than France, says Appleby.

The latter is true, but what this claim doesn't show is that the UK has actually had the largest fall in heart attack deaths between 1980 and 2006 of any European country. And if trends over the last thirty years continue, the UK will have a lower death rate than France as soon as 2012, he writes.

These trends have been achieved not only with a slower rate of growth in health care spending in the UK compared with France, but at lower levels of spending every year for the last half century, he adds.

Our apparently poor comparison with other countries on cancer deaths has also been a key argument for reforming the NHS, says Appleby.

He points out that cancer outcomes in this country are improving, although comparisons are not straightforward and some of the data often cited should be treated with caution.

Breast cancer deaths in the UK have fallen by 40 per cent over the last two decades to virtually close the gap with France.

Again, if trends continue, it is likely that the UK will have lower death rates than France in just a few years, he says.

And despite headlines that the UK is the 'sick man of Europe', trends actually show improvements in survival rates for the UK, he adds.

Appleby says: "Comparing health outcomes across countries is complex and not simply down to healthcare spending, but these trends must challenge one of the government's key justifications for reforming the NHS."

Provided by British Medical Journal