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UK ‘can and should do better’ in many areas of healthcare

Scores worse than similar countries in many areas – but better for flu jabs and antibiotic prescribing

Louise Prime

Friday, 03 July 2015

The UK can and should do better in preventing unnecessary hospital admissions and improving survival from some of the biggest killer diseases, the Nuffield Trust revealed this morning. In a new report comparing performance across up to 15 high-income countries, it also said that the UK is performing better than most others in several areas related to general practice, including influenza immunisation rates, and shows evidence of good antibiotic prescribing practice.

The authors of Focus on: international comparisons of healthcare quality found that the UK does not consistently overperform or underperform compared with other countries – across all of the 27 care quality indicators used, the UK’s healthcare system is better than average in some areas, but it requires significant improvement in others where it lags behind most other similar countries in the Organisation for Economic Co-operation and Development (OECD).

  • Areas in which the UK is performing relatively well include antibiotic prescribing in primary care, breast and cervical cancer screening, diabetes (both lower extremity amputations and admissions for complications and uncontrolled diabetes without complications), and suicide deaths after discharge in people with a diagnosed mental disorder.
  • The UK performs similarly to other countries in colorectal cancer mortality, COPD admissions, diphtheria, tetanus and pertussis immunisation, measles immunisation and suicide deaths after discharge in people with bipolar disorder or schizophrenia.
  • However, the UK performs worse than most countries in asthma admissions; in both admission-based 30-day mortality in hospital and person-based AMI 30-day mortality in and out of hospital for acute myocardial infarction (AMI), ischaemic stroke and haemorrhagic stroke; both mortality and 5-year relative survival for both breast and cervical cancer; colorectal cancer 5-year relative survival; and in inpatient suicide among those diagnosed with mental disorders and those with bipolar disease or schizophrenia.

Overall, the UK is performing better than most of the comparator countries on five out of the nine indicators representing primary care, including influenza vaccination rates, which are consistently higher than in many OECD countries. But its performance is deteriorating on two indicators: diphtheria, tetanus and pertussis (DTP) vaccination coverage (between 2012 and 2013) and the volume of antibiotics prescribed.

The report’s authors said: “The over-use of antibiotics is an issue of global concern. Although the volume of antibiotics prescribed in the UK is rising, overall rates tend to be lower than those in other countries, but higher than Germany, the Netherlands or Sweden. However, there are indications that the UK is prescribing a decreasing proportion of second-line antibiotics (cephalosporins and quinolones) – restricted for situations when first-line antibiotics have failed – which is an indication of good prescribing practice.”

The report also found that the UK’s rates of notionally avoidable hospital admissions are relatively low for diabetes, but relatively high compared to the best performers for asthma and chronic obstructive pulmonary disease (COPD). Monica Fletcher, chief executive of Education for Health, commented: “It is encouraging to observe a decline in the rate of hospital admissions for COPD in the UK which is comparable to other European countries, but the rate is somewhat disappointing considering the amount of investment during the same time period in prescribed therapies. We are one of the countries with a higher rate of hospital admissions for asthma and the rate in decline is also disappointing.”

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