NHS Falling Behind International Healthcare Systems

According to a report by QualityWatch (a joint Nuffield Trust and Health Foundation research programme), the NHS is falling behind other countries when it comes to preventing unnecessary hospital admissions and improving survival rates.

In the report, entitled ‘International Comparisons of Healthcare Quality’, QualityWatch assessed 27 different care quality indicators across 15 countries and analysed international healthcare data in order to obtain a relative comparison of the quality of healthcare in the UK and identify any issues such as excessive cases of clinical negligence and instances of cancer misdiagnosis.

QualityWatch compared the performance of the healthcare systems of Australia, Belgium, Canada, France, Germany, Greece, Ireland, Italy, Netherlands, New Zealand, Portugal, Spain, Sweden, United Kingdom and United States against 27 of the Organisation for Economic Co-operation and Development’s Health Care Quality Indicators. These key indicators cover the four main healthcare sectors: primary care, acute care, cancer care and mental health.

Although there are many “quality of care” indicators in use in the NHS, the 27 indicators discussed in the report represent the most robust data currently available as a basis for the comparison of healthcare systems across several countries. As the key care indicators are selective and only touch upon quality of care in healthcare systems where validated comparative indicators are available, QualityWatch were keen to point out that the report should not be considered a definitive judgement on the quality of care in the UK, but as an additional lens through which to better understand national performance over time.

The report revealed that the UK had lower cancer survival rates and higher death rates from heart attacks and strokes than many of the other countries, although on measures such as immunisation and antibiotic prescribing the UK performed much better. The low cancer survival rates could be attributed to late diagnosis of cancer, while the higher rate of death from heart attacks and strokes could be linked to the high level of obesity in the UK. Although new cancer guidelines could help to save lives in the future, there is still much work to be done.

Christopher Livingston, clinical negligence solicitor at Blackwater Law solicitors in Essex, said: “The UK’s poor performance in terms of cancer survival rates compared to other western countries continues to be a concern. Initiatives such as the new cancer guidelines are an important step towards combatting this, but ultimately results will not be forthcoming unless frontline healthcare services receive the resources they so desperately need to provide the health care services we have all come to expect.”

Key Findings

The report compared the performance of the various international healthcare systems from 2000 to 2013. Among the key findings were:

  • Immunisation rates were generally higher in the UK, which suggests the current system for providing universal care was performing well
  • Although the amount of antibiotics prescribed in the UK was on the rise, the overall volume of antibiotics administered to patients tended to be lower than in many other countries
  • Rates of avoidable hospital admissions were high for conditions such as asthma and respiratory disease
  • Death rates for stroke and heart attacks, while improving, tended to be higher than other countries
  • On cancer care, while screening rates remained high, survival and death rates were still worse than other nations

Where is the NHS Falling Behind?

Primary Care

Rates and trends for a selection of primary care indicators used as a proxy for the quality of primary care suggest some excellent performance but also raise some important concerns.
Influenza vaccination rates are relatively high and have been improving, while childhood vaccination rates have also been increasing over time. Overall antibiotic prescribing rates, while relatively low, have been on the increase, and the number of potentially preventable admissions for diabetes are relatively low. However, the prescribing of cephalosporins and quinolones is low and on the decline, while the amount of preventable admissions for other chronic conditions such as asthma and Chronic Obstructive Pulmonary Disease (COPD) remain relatively high.

Acute Care

Although reported mortality rates for victims of strokes in the UK have fallen, they remain higher than those in the other countries. While efforts to improve the quality of acute care services continue, the difference in stroke and AMI mortality rates between the UK and the comparator countries is of some concern and needs to be understood and reduced further over the coming years.

Cancer Care

Cancer survival, together with cancer screening coverage and mortality, are commonly indicators for the quality of cancer care. Despite ongoing initiatives and attention focused on this area in recent years, the UK’s performance in terms of cancer diagnosis and cancer care is mixed and there is much room for improvement.

The UK is stagnating or significantly lags behind other countries in relation to cancer survival and mortality rates, raising concerns about potential delays in diagnosing cancer, cancer misdiagnosis and how quickly patients are able to get access to effective treatment.

Nuffield Trust chief executive Nigel Edwards said: “Interpreting international data on healthcare systems is notoriously tricky and any comparison should be handled with care.

“However, it is clear from this analysis that the UK can and should do better.

“Our poor performance on cancer survival compared with other leading countries is well-known and continues to be a concern.

“We enter the new parliament with a mountain to climb in reducing preventable hospital admissions and improving survival from common killer diseases, all at a time of continuing austerity affecting public services.”