Mixed review for NHS in global comparison

A GLOBAL comparison of healthcare systems has found that that NHS performs worse than average in the treatment of eight out of the 12 most common causes of death – but provides unusually good financial protection to the public from the consequences of ill health.

The independent report – How good is the NHS? – looked at three aspects of what constitutes a good healthcare system, comparing the UK to 18 similar developed countries, including France, Germany, Italy, Japan and the USA.

It found that the NHS performs worse than average in the treatment of eight 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.

The NHS is also the third poorest performer in 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.

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.

But the NHS did compare well in some key areas. 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 per cent in 2016 compared to an average of 7.2 per cent across the comparator countries.

The NHS is also relatively efficient with the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent.

It performs well in managing patients with some long-term conditions, such as 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.

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 authors warn that international comparisons of this type offer only 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."

The report was published by the Nuffield Trust, the Health Foundation, the Institute for Fiscal Studies and The King’s Fund.