Performance of UK National Health Service compared with other high income countries: observational study

Abstract

Objective: To determine how the UK National Health Service (NHS) is performing relative to health systems of other high income countries, given that it is facing sustained financial pressure, increasing levels of demand, and cuts to social care.

Design: Observational study using secondary data from key international organisations such as Eurostat and the Organization for Economic Cooperation and Development.

Setting: Healthcare systems of the UK and nine high income comparator countries: Australia, Canada, Denmark, France, Germany, the Netherlands, Sweden, Switzerland, and the US.

Main outcome measures: 79 indicators across seven domains: population and healthcare coverage, healthcare and social spending, structural capacity, utilisation, access to care, quality of care, and population health.

Results: The UK spent the least per capita on healthcare in 2017 compared with all other countries studied (UK $3825 (£2972; €3392); mean $5700), and spending was growing at slightly lower levels (0.02% of gross domestic product in the previous four years, compared with a mean of 0.07%). 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 utilisation (number of hospital admissions). The UK had slightly below average life expectancy (81.3 years compared with a mean of 81.7) and cancer survival, including breast, cervical, colon, and rectal cancer. Although several health service outcomes were poor, such as postoperative sepsis after abdominal surgery (UK 2454 per 100 000 discharges; mean 2058 per 100 000 discharges), 30 day mortality for acute myocardial infarction (UK 7.1%; mean 5.5%), and ischaemic stroke (UK 9.6%; mean 6.6%), the UK achieved lower than average rates of postoperative deep venous thrombosis after joint surgery and fewer healthcare associated infections.

Conclusions: 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.

Fig 1

Total expenditure on health in UK, comparator countries, Organization for Economic Cooperation and Development (OECD) member nations, and European Union (EU) member nations. Values for average annual growth rates are for indicated 4 year periods and are shown only for UK and average of comparator countries. Values for UK came from Office for National Statistics because they are consistent with years before implementation of System of Health Accounts (SHA) in 2011. More detailed information on SHA and differences between two accounting methods can be found in online technical appendix. An alternative to this figure, which has OECD reported values under SHA classifications for UK, is also available in supplementary figure A. GDP=gross domestic product

Fig 2

Annual inflow of foreign trained workforce in UK. Top: Annual inflow of foreign trained nurses into UK. Bottom: Annual inflow of foreign trained doctors into UK. All data are presented as foreign trained workforce from European Union (EU) nations, non-EU nations, and total

Fig 3

Total population life expectancy at birth in UK, average of comparator countries, average of Organization for Economic Cooperation and Development (OECD) member countries, and average of European Union (EU) member countries