King’s Fund report gives NHS mixed bill of health

The NHS is ‘neither a leader nor a laggard’ when compared to health care systems of similar countries, though on some critical measures of resources and performance the UK is falling well-below average, according to a major new report from The King’s Fund.

The analysis of healthcare systems in 19 different countries finds that the NHS offers people good protection from the potentially catastrophic costs of ill health. The researchers also found that the UK health service is among the most efficiently run health care systems, for example by spending relatively little budget on administration and keeping medicines costs low.

But the UK has below average health spending per person compared to other countries and underperforms significantly on many key healthcare outcomes, including cancer survival rates and life expectancy.

The report titled: How does the NHS compare to the health care systems of other countries? has been published ahead of the 75th anniversary of the founding of the NHS, shows that the UK has strikingly low levels of key clinical staff, with fewer doctors and nurses per head than most of its peers, and a heavier reliance on internationally trained staff. The UK has just three doctors per 1,000 people, while Greece has more than twice as many, with 6.3 doctors per 1,000 people.

The UK also spends less than many of its peers on physical resources such as buildings and equipment and comes bottom out of 19 countries for the number of CT and MRI scanners per person. The US has five times as many scanners per person and Germany has four times as many.

The report authors conclude that there is little evidence one individual country or model of health care performs consistently better than another across a range of performance measures. The report finds that countries raise their standards of health care mainly by reforming and improving their existing model of health care rather than by adopting an alternative model.

Other key findings include:

  • Of the 19 countries assessed, the UK has among the lowest levels of life expectancy (LE) for men and women, with falls in life expectancy being particularly striking since the pandemic. Since 2020, only the US has had consistently lower male and female LE than the UK. While life expectancy is determined by many more factors than just health care, the UK has higher levels of deaths from treatable diseases such as heart attack and stroke than the majority of its peer countries, and below average survival rates for many major cancers.
  • The UK has relatively few hospital beds: 2.5 beds per 1,000 people compared to an average of 3.2, placing the UK second to last out of 19 peer countries.
  • The UK spends just 1.9% of health spending on administration; the sixth lowest out of all the countries measured. The proportion of admin spend is significantly lower than the United States, which spends 8.9% of health spend on admin, and France, which spends 5.5%.
  • Relatively few members of the UK public have skipped seeking medical care due to cost and only a small number have trouble with medical bills, compared to other countries. Just one in 10 people think the cost of accessing treatment is a big problem.
  • Waiting times in the UK for common procedures like knee, hip and cataract operations were broadly middle of the pack compared to similar countries. Like in the UK, many countries in the analysis had rising waiting lists before the COVID-19 pandemic, but the fall in planned operations like these was dramatically sharper in the UK in the first year of the pandemic.

Commenting on the research, Siva Anandaciva, Chief Analyst at The King’s Fund and author of the report, said: “As the NHS turns 75, the much-loved British institution has sadly seen better days. While the UK stands out in removing most financial barriers to accessing health care and the NHS is run relatively efficiently, it trails behind its international cousins on some key markers of a good health care system. The pressures of the Covid-19 pandemic on our health service compounded the consequences of more than a decade of squeezed investment in staff, equipment and wider services that keep us well. This leaves the NHS delivering performance that is middling at best and the UK must do much more to reduce the number of people dying early from diseases such as heart disease and cancer.”

  • How does the NHS compare to the health care systems of other countries? Has been authored by Siva Anandaciva, Chief Analyst at The King’s Fund and published by The King’s Fund on Monday 26 June 2023. Click here to read the full report and summary.

The 19 countries included in the analysis are: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, Netherlands, New Zealand, Portugal, Spain, Sweden, the UK and the US.


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