NHS receives mixed scorecard in major analysis of international health systems

Our commitment to healthcare free at the point of use means the UK’s NHS is world-leading in ensuring people are protected from financial hardship when they need treatment. But the NHS underperforms compared to other similar countries in preventing deaths from killer diseases such as cancer and heart attacks.

The NHS also has fewer doctors, nurses, hospital beds and CT and MRI scanners than other countries and spends a slightly below average proportion of national income on healthcare.

That’s according to a major new analysis of the NHS in an international context published for the BBC as part of their programming for the NHS’s 70th birthday [1].

The report, entitled How good is the NHS? and published by the Nuffield Trust, the Health Foundation, the Institute for Fiscal Studies and The King’s Fund, looks at three aspects of what constitutes a good healthcare system in the UK compared to 18 similar developed countries, including France, Germany, Italy, Japan and the USA [2].

The three aspects examined are: the speed and accessibility of care; the efficiency of the system; and the outcomes it achieves. It also looks at what the health service has to work with in terms of money, staff, equipment and the health of the population [3].

Key strengths of the UK’s NHS include:

• It provides unusually good financial protection to the public from the consequences of ill health. For example it has the lowest proportion of people who skipped medicine due to cost (2.3% in 2016 compared to an average of 7.2% across the comparator countries).
• It is relatively efficient: the UK has the largest share of generic prescribing of all comparator countries, at 84% in 2015 compared to an average of 50%.
• It performs well in managing patients with some long-term conditions like diabetes and kidney diseases: fewer than one in a thousand people are admitted to hospital for diabetes in a given year, compared to over two in a thousand admitted in Austria or Germany.

Key weaknesses include:

• The UK’s NHS performs worse than the average in the treatment of 8 out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years. [4]
• It is the third poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’).
• It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): 7 in 1000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries.

Other findings include:

• The UK is in the middle of the pack when it comes to the length of time people wait for treatment: people requiring a hip replacement waited around 97 days in the UK in 2015, compared to 150 days in Spain and 42 days in the Netherlands. A&E waits are also average, according to survey data.
• The NHS has a lower than average number of staff for all professional groups except midwives: in the UK there is one doctor for every 356 people, compared to one for every 277 people on average across the comparator countries.
• The UK has very low levels of hospital beds and the lowest levels of both CT and MRI scanners: it has fewer beds per person than 16 of the 18 other countries.

The authors warn that international comparisons of this type offer a partial picture at best, with limited or patchy data meaning that several areas like mental health cannot be compared internationally.

Commenting on the report, Nigel Edwards, Chief Executive of the Nuffield Trust said:

“Discussion about the NHS is often marked by an unhelpful degree of exaggeration, from those that claim it is the envy of the world to those who say it is inferior to other systems. The reality is a much more mixed picture, but one thing is clear: we run a health system with very scarce resources in terms of staff and equipment and achieve poor outcomes in some vital areas like cancer survival.”

Dr Jennifer Dixon, Chief Executive of the Health Foundation said:

“Compared to the other 18 countries the UK has middling funding and middling performance overall. We can be proud of the fact that the UK is a standout nation where people are not put off from seeking care due to cost, and the NHS is cheap to run. But austerity has bitten hard, and the lag of investment shows. If we want to hold our head up high next to our European neighbours we can and must do better.”

Paul Johnson, Director of the Institute for Fiscal Studies said:

“The truth about the NHS is that by international standards it is a perfectly ordinary healthcare system, providing average levels of care for a middling level of cost. Access is good and people are protected from high costs, but its performance in treating people with cancer is poor, and international comparisons suggest too many people in the UK die when good medical care could have saved their lives.”

Chris Ham, Chief Executive of The King’s Fund said:

"As it turns 70, the NHS is neither performing as well as its supporters sometimes claim, nor as badly as its critics often allege. While this is a moment to celebrate its many achievements, the evidence that the NHS lags behind other countries in reducing premature deaths from diseases like cancer and heart attacks is a timely reality check. The UK stands out in removing financial barriers to people accessing care but needs to do better in improving health outcomes.”