Hospital bed utilisation in the NHS and Kaiser Permanente: debate about Kaiser needs transparency and hard evidence.

Editor—The article by Feachem et al comparing Kaiser with the NHS attracted much attention, not least from the Department of Health.1 However, the authority of the debate is diluted by the way in which the article by Ham et al was published.2 Firstly, Ham did not declare any competing interests. The Department of Health, for which he is strategy director, is currently running pilot studies in seven primary care trusts, adapting elements of the Kaiser model. He therefore has a vested interest in showing that the model his team has advocated performs better than the NHS. Secondly, the conclusions of the paper were presented as fact in the summary box “What this study adds.” The paper implies that Kaiser has accomplished its better acute bed utilisation through integration of care, active management of patients, and the use of intermediate care, self care, and medical leadership. Neither it nor Feachem et al's paper present any evidence that this is the case: these claims are either speculative or based on their own analysis of the Kaiser system. Whether Kaiser achieves better bed utilisation and how this is achieved has not been conclusively shown. The presentation of the paper in this way does not promote debate but weakens it. The Department of Health set up pilots modelled on aspects of the Kaiser system on the basis of Feachem et al's flawed article, which was surely intended only to initiate debate. Unsubstantiated conclusions should not be presented as fact to fuel another fruitless political exercise. Unfortunately, the primary care trust pilots will all omit the most important distinction of the Kaiser system—that it is not run by politicians.