The word of the day for the UK at this morning’s OECD launch of Health at a Glance was ‘mediocre’. Looking across hundreds of indicators of health system performance – from quality, to access to funding, the OECD’s bumper stats fest made for sobering reading.
The OECD does show that the UK has excellent health care coverage, with equal access to care highlighted as an area of success. Less promising, however, is how we perform with overall health status, risk factors (alcohol, smoking, diet) and - as we made clear earlier this year – healthcare quality. We also are spending just below the OECD average on healthcare.
It’s extremely difficult to unpick what all of this means. Any look at healthcare through the lens of data alone is likely to only tell part of the story. For example, the OECD’s data on preventable asthma admissions in the UK suggests problems in primary care, yet we seem to be doing very well on preventable admissions for diabetes. This is genuinely an area where the cliché that ‘further research is required’ applies.
The data do show that a rigorous and relentless focus can produce results – as it does in the waiting times measures looked at in the report – but there are severe limits on how many areas it is possible to focus on.
Nonetheless the OECD’s work – and our own analysis through our joint QualityWatch programme with The Health Foundation – does enable us to draw some conclusions:
1. We're getting what we pay for
The first is that, where UK health is concerned, you get what you pay for. We’re spending just under the OECD average on healthcare – 8.5 per cent of GDP compared to the average of 8.9 per cent and well below our European peers. The answer is not all about money, but the fact that our outcomes are also, in many cases, middling to low should not be a surprise.
2. We're not accounting for our ageing population
The second is that the funding situation shows no signs of improving any time soon. Expenditure on healthcare has been slowing in most OECD countries – austerity and the impact of slow wage growth is not unique to the UK. But our rate of growth on healthcare spending has been much slower than equivalent economies.
This means we’re going to be keeping spending static when adjusted for the ageing and growing population. The OECD is critical of all health systems for being too slow to adapt to the challenges posed by people living longer with multiple conditions. For the UK, this is combined with growing demand for expensive drugs, rising expectations about seven-day services, and pressures on other areas like social care and public health. Put simply, the sums look increasingly unlikely to add up.
3. We're struggling with the basics
A third conclusion is that, as Mark Pearson of the OECD made clear, improving our health outcomes will require us to get some of the basics right. This means seriously addressing the lifestyle problems the OECD highlights, ensuring high quality social care and care in the community and ensuring that basic clinical processes and systems are well functioning. Part of that is about having the right staff in the right place at the right time.
A striking finding in today’s report is that we have fewer doctors and nurses than most other countries. Just to get to the OECD average would require approximately 26,500 extra doctors and over 47,000 extra nurses, at a cost of billions to the health service. When we’re struggling to fill vacancies, and hospitals are heavily reliant on agency staff to fill the gap, achieving this seems highly unlikely.
4. We're missing the opportunity to compare UK countries
Finally, we’re still somewhat in the dark about how healthcare performance varies between the devolved countries of the UK. Despite having the opportunity for a fantastic natural experiment to understand this, there is a paltry - and declining - lack of comparable data. The lack of curiosity displayed by any of the four countries of the UK about what they might learn from one another is worrying.
So what needs to happen next? Our inability to get the basics right should be leading us to ask some searching questions about the way the system is currently working.
A key feature about the NHS that is not captured in the data from the OECD is a system subject to almost continual reorganisation and run in a top-down way from the centre – whether that’s edicts being issued from regulators on the finances or the Secretary of State getting stuck into the minutiae of banding levels for junior doctors.
The dysfunctions of such an approach are well known – too much reform, too much upward management and not enough faith put in the professionalism of NHS staff. The OECD points out that we seem to be excellent at health policymaking, yet we falter when it comes to implementing policy. Whilst other countries have less data and fewer top-down policy levers, they often do better at driving quality from the bottom up.
Perhaps if we allowed clinicians the time and headspace to implement their own solutions to improve healthcare quality, the UK’s overall standing compared to other OECD countries would be much better.
Edwards N and Kossarova L (2015) ‘UK healthcare: getting the basics right’. Nuffield Trust comment, 4 November 2015. https://www.nuffieldtrust.org.uk/news-item/uk-healthcare-getting-the-basics-right