UK healthcare lags behind other wealthy countries and is only expected to get worse, warns a major study published today.
Standards of care in the NHS in key areas such as stroke, heart attack and cancer survival were compared to nine other high income nations.
Quality ‘seems to be slipping’, the British and US researchers warned, while countries such as France and Australia forge ahead.
The UK 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.
Less money and time is spent on each patient’s care – and there are also fewer medical staff and hospital beds 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 only expected to decline further.
Standards of care in the NHS in key areas such as stroke, heart attack and cancer lags behind other wealthy countries and is only expected to get worse, warns a major study
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.
‘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.
WHAT AREAS DO THE NHS FARE WORSE ON?
- Spending: The UK had the lowest healthcare expenditure per capita of £2,972 ($3,825, €3,392) compared with the average of £4,432 ($5700, €5,194). However this was roughly in line with the average healthcare expenditure of EU member states of £2,806 ($3,616, €3,289).
- GDP: The UK spent approximately 8.7 per cent of GDP compared with the study average of 11.5 per cent in 2017.
- Growth in spending: Spending is growing at slightly lower levels – 0.02 per cent of GDP in the UK from 2014-17 compared with an average of 0.07 per cent.
- Social spending: As a percentage of GDP, social spending was 19.6 per cent in the UK, which was similar to the study average of 20.1 per cent. However, UK social spending had been declining at a faster rate than all three groups.
- Doctors: The number of practising physicians in the UK was below the study average in 2017, with 2.8 per 1,000 population compared to the study average of 3.5 per 1,000.
- Nurses: The UK was the only country to experience a decrease in the number of nurses from 2010 to 2017 by 0.6 nurses per 1,000 population compared to the 0.4 study average. The numbers of nursing graduates per 100,000 people are nearly half the number of nursing graduates in comparator countries.
- Fewer hospital beds: The UK had 2.5 beds per 1,000 population compared with four per 1,000 in comparable countries. The number has decreased at a similar rate.
- Appointment times: No doctors reported spending 25 minutes or more with their patients compared to the average of 15 per cent. Some 90 per cent reported spending less than 15 minutes with their patients compared to the study of 38 per cent.
- Life expectancy: The UK had a life expectancy of 81.3 years compared with an average of 81.7.
- Survival after cancer: The UK had the lowest survival rates for breast cancer and colon cancer (85.6 per cent and 60 per cent, respcitvely, compared with 87.4 per cent and 64.8 per cent). The UK has the second lowest for rectal cancer (62.5 per cent compared with the average, 66.6 per cent) and cervical cancer (63.8 per cent compared with average 66.6 per cent).
- Deaths after a stroke or heart attack: Three day mortality after an ischaemic stroke is 9.6 per cent compared to the average of 6.6 per cent. For heart attack, the rate is 7.1 per cent compared to 5.5 per cent.
- Foreign doctors: The proportion of foreign trained doctors as a percentage of total doctors in the UK in 2017 was greater than average, with 28.6 per cent doctors and 15 per cent nurses.
- Doctors satisfaction: Only two per cent of UK doctors were dissatisfied with the time they were able to spend with patients compared to the average of 13 per cent.
- Flu vaccines: The rate for immunisation among over 65s was above average at 72 per cent compared with the average 54 per cent.
- Breast and cervical cancer screening: Some 75 per cent of women aged 50-69 have breast cancer screening compared with the average of 66.5 per cent in other countries. For cervical cancer, the rates are 75 per cent compared with 71 per cent. However, screening rates have declines at faster rates in recent years in the UK.
- Superbugs: The prevalence of healthcare associated infections in the UK was 5.2 per cent compared with the average 6.6 per cent. However, rates were higher for postoperative sepsis after abdominal surgery – 2,454 per 100,000 discharges compared to an average of 2,058.
‘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.’
Professor Papanicolas and a team at Harvard University, Boston, 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 per cent of GDP in the previous four years – compared with an average of 0.07 per cent.
Professor 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. However, screening uptake was higher in the UK.
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.
Professor 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 per cent) and nurses (15 per cent).
However, the UK still has the biggest shortfall in healthcare professionals – and these numbers are declining.
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 people admitted to hospital was lower than average.
Professor Papanicolas said: ‘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.’
‘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.’
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.