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UK health service 'lagging behind' services in similar countries

The UK spends far less on health than other high-income countries and has fewer staff per patients

Ingrid Torjesen

Thursday, 28 November 2019

The UK NHS is “lagging behind” other high-income countries in terms of spending, staffing, patient safety and population health, a study* published by The BMJ shows.

If the NHS wants to achieve comparable health outcomes to these countries, it needs to spend more to increase staffing numbers, long-term care, and other social services, the researchers warn.

They compared the UK health system with those of nine other high-income countries (Australia, Canada, Denmark, France, Germany, the Netherlands, Sweden, Switzerland, and the US), across seven key areas including spending, structural capacity, accessibility, quality, and health outcomes.

The focus was on the most recent data available, typically 2017, as well as trends since 2010 when available and comparable.

These comparator countries were chosen because they are all high-income countries that the UK tends to liken itself to, with populations that face similar burdens of illness, yet also have healthcare systems structured in different ways.

The results showed that the UK spent the least per person on healthcare in 2017 ($3825; £2955) compared with an average $5700 for all other countries studied, and healthcare spending grew at slightly lower levels (0.02% of GDP in the UK from 2014-17 compared with an average of 0.07%).

The UK had among the highest proportion of foreign trained doctors (28.6%) and nurses (15%), but despite this, the numbers of healthcare professionals (general practitioners, specialists, nurses) are some of the lowest of all countries studied (UK 2.8 doctors per 1000 population compared with 3.5 study average), and these numbers are declining.

Waiting times and access to care in the UK compared favourably to other countries, but utilisation (number of hospital admissions) was lower than average.

The UK had slightly below average life expectancy (81.3 years compared with an average of 81.7), the lowest survival rates for breast and colon cancer, and the second lowest survival rates for rectal and cervical cancer. Maternal death in the UK was higher than average, and is increasing, while the numbers of preventable and treatable deaths were the third highest and highest respectively.

Although several outcomes were poor, such as death rates for heart attack and stroke, the UK achieved lower than average rates of deep venous thrombosis after joint surgery and fewer healthcare associated infections.

Although the UK has comparable numbers of people over the age of 65, it spends less of its already low total healthcare expenditure on long-term care - and a greater proportion of this comes from private sources than it does in other healthcare systems.

The authors conclude that while the NHS shows pockets of good performance, spending, patient safety, and population health are all below average to average at best.

"Taken together, these results suggest that if the NHS wants to achieve comparable health outcomes at a time of growing demographic pressure, it may need to spend more to increase the supply of labour and long-term care and reduce the declining trend in social spending to match levels of comparator countries," they conclude.


*Papanicolas I, Mossialos E, Gundersen A, et al. Performance of UK National Health Service compared with other high income countries: observational study. BMJ 2019; 367 :l6326

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