Feature

The Danish talking cure

I doesn’t take a referendum to get the Danes involved in shaping national policy on health. David Seedhouse reports on a model of participation from which the UK would do well to learn

Paradox is everywhere in post-election Britain. We want improved public facilities — safer roads, better health care, cleaner streets -- but we want more individual freedom as well: less tax, more consumer choice, hospitals like hotels. Personal accountability and responsibility are buzz words, yet most important decisions are taken by the chosen few. With one eye we gaze towards a Europe which emphasises welfare and social democracy, while with the other we covet the American dream of a free market in medical services.

Those who prefer the European approach might look to Denmark for fresh ideas. Four decades ago the Danes decided to copy the new-born NHS and today enjoy a health service funded almost totally by the tax-payer, firmly protected by Danish law, and freely available to all. The Danes are proud of a system which has not only kept pace with major technological advance, but guarantees help to all citizens should they need it. Despite pressure from a lobby of politicians and economists, the Danish people are confident that their health service will not be hijacked. The majority will have no truck with alternative systems which threaten to drag health care away from basic principles. Cost matters, efficiency matters, not being wasteful matters. But being fair matters more.

The British public has very little say in shaping any developments within the NHS, so why are the Danes so sure that social justice will prevail? What extra protection against harsh economic trends do the Danes have? It is not that the Danish system is problem free. Difficult choices over resources have to be made as much by the Danes as any other developed nation. In response they have chosen to cut-back some services, but only where they see other good reasons to do so. Long-stay institutions for the elderly and mentally ill have been closed to reduce costs, but also in the belief that the move to the community would benefit most patients. However, the result has been that many old people now feel isolated, and yearn for a return to the institutional community, while young mentally ill people placed outside hospital have been found to be much more vulnerable to suicide.

The Danish reaction to this, and other policy dilemmas could hardly be more unlike the British response. For the Danes public planning means exactly what it says — the public must do the planning. And it is this thoroughly democratic approach to problem-solving that makes the Danes so positive that health care principles will continue to control the profit motive.

If the Danes have a problem everybody talks about it. Debate takes place in the open even about issues which we have been taught to think of as ‘far too difficult’ for most of us. If a group of Danish people wants to discuss topics such as the human genome project, criteria for brain death, health care priorities, or care of the elderly then they are encouraged to do so.

The Danish government annually sets aside several million Krona to fund public meetings all over the country. Anyone can set up an ‘education club’ — if local people want a forum on a health care topic, then as a legal right they can obtain funding for teachers and access to meeting rooms. If the clubs feel they have something to say they are welcome to write to the relevant government minister, who will take their advice into account. Suggestions are always taken seriously, and often acted upon. Recently, as a direct result of the wishes of numerous groups of ‘ordinary Danes’, the government established a Council of Ethics with the brief to further enhance public awareness of ethical issues.

Opponents of the ‘Americanization of Britain’ might take heart from the Danish reverence for open debate. If our European neighbours can do it so can we. Certainly the logic is compelling. Since Denmark is for all Danes equally, all Danes have an equal personal interest and investment in it. So, all Danes should have a say, and should be listened to, in the debate over their national life. Speaking with Danes it is a rare conversation which does not, before too long, turn to an issue ‘which we are presently discussing’ or ‘which is being debated’. It takes a while to realise that they are not referring only to Parliamentary sessions, or ‘select committees’, but everyday conversation between ‘Danes in the street’. But once you know it you appreciate an overwhelming feeling that there might just be something the individual can do about public life.

Danish people are humorous and easy-going, but insist on serious discussion when necessary. Habitually inquisitive the Danes expect to think for themselves, and enter debates with a relish which ensures rich and varied conversation. It is for this reason that principles of care are likely to remain safe in Denmark, protected by real democracy from the simple-minded onslaught of the ‘grand market solution’. Talking as the Danes do is the best antidote available to the childish, yet increasingly dominant belief that if you get costs right you get everything else right too. Educated public conversation is a tradition which we desperately need to inherit. The Danes copied the NHS, perhaps now they can return the favour, and help us resolve our paradoxes.