Standards of healthcare in Britain “lag behind” other wealthy countries – and quality “seems to be slipping,” warns a major new study.
The NHS performs badly in key areas such as stroke, heart attack and cancer survival compared to nine other high income nations.
It has the lowest survival rates for breast and colon cancer,and the second lowest for rectal and cervical cancer, according to the findings published in The BMJ.
Spending is lower per head – and there are also fewer medical staff for the population.
There are just 2.8 doctors for every 1,000 people – compared to an average of 3.5 elsewhere.
And the numbers are declining. Improvements will require more spending on the workforce and long term care, warn the British and US team.
Study lead author Professor Irene Papanicolas, of the London School of Economics and Political Science, said: “The NHS showed pockets of good performance, including in health service outcomes.
“But spending, patient safety, and population health were 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.”
The NHS faces the challenge of having to meet growing demand while under pressure to reduce costs. But data relative to similar countries has been lacking.
So – working with colleagues at Harvard University, Boston – Prof Papanicolas’ team compared seven key areas with government health systems in Australia, Canada, Denmark, France, Germany, the Netherlands, Sweden, Switzerland and the US.
They included spending, structural capacity, accessibility, quality and health outcomes.
The UK spent £2,972 per capita on healthcare in 2017 – the least of all other countries analysed. The average was £4,432.
Spending was also growing at lower levels – 0.02% of GDP in the previous four years – compared with an average of 0.07%.
Prof Papanicolas said: “The UK had the lowest rates of unmet need and among
the lowest numbers of doctors and nurses per capita, despite having
average levels of hospital admissions.
The UK had slightly below average life expectancy – 81.3 years compared with
an average of 81.7. Survival from breast, cervical and bowel cancer was also lower.
There were also higher numbers of blood poisoning, or sepsis, after abdominal surgery – 2,454 per 100,000 discharges compared to an average of 2,058.
There were also more deaths after a stroke or heart attack – 9.6 and 7.1% respectively, compared to averages of 6.6 and 5.5%.
Pregnancy related deaths were higher than average, and are increasing, while the numbers of preventable and treatable deaths were the third highest and highest, respectively.
On the other hand, the UK achieved lower than average rates of postoperative deep venous thrombosis after joint surgery and fewer cases of hospital superbugs.
The findings are based on data from international organisations such as Eurostat and the Organisation for Economic Cooperation and Development (OECD).
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.
Prof Papanicolas said: “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.
When it comes to the healthcare workforce, the UK had among the highest proportion of foreign trained doctors (28.6%) and nurses (15%).
As the migration of healthcare professionals has decreased since 2015, the existing staffing challenges facing the NHS “will likely be further exacerbated,” said the researchers.
Waiting times and access to care in the UK compared favourably to other countries, but the number of hospital admissions was lower than average.
Prof Papanicolas said: “In this study, based on aggregated data from recent years, the
UK was consistently the country that spent the least on healthcare per capita compared with nine other high performing health systems.
“In particular, our study suggests the NHS should look towards improving staffing ratios, long term care provision, and social spending, which are lower than comparator countries and have been declining in recent years.”
She added: “Despite already low levels of labour, the UK is making do with fewer doctors and nurses, a challenge that is likely to be exacerbated in the context of Brexit.
“Although access to care compared favourably to other countries, utilisation was lower than average and quality seems to be slipping. Health service outcomes, as well as heath status, are sub-optimal.
“This work suggests although the NHS has done a remarkable job in managing the constrained funding environment, the broader challenges are such that if the UK wants an NHS that remains high performing and a nation with good health outcomes, it will almost certainly need to spend more on healthcare staffing, long term care, and other social services, which lag behind comparators.”