Owen Paterson is a former Environment Secretary and is MP for Shropshire North. He is Chairman of UK2020.
The National Health Service is regarded by many as more than a means of providing medical care. It seen as one of the greatest achievements of post-war Britain. This is why it is rare for anyone in public life to say that it is a bad system of healthcare.
However, the point has now been reached where it would be moral cowardice for us not to face up to the truth that the NHS works badly compared to other healthcare systems around the world. My think tank UK 2020 publishes a report today in answer to a simple question: ‘How do NHS health outcomes compare with those of comparable countries around the world?”
The UK Health System, an international comparison of health outcomes is an objective look at data from well-respected sources – the OECD, Lancet, and Eurocare, amongst others. I could see that the NHS enjoys enormous loyalty, but on the other hand newspaper headlines and anecdotal suggested otherwise. So I wanted to take a clear-eyed look at the evidence.
The report finds that there are over 46,000 unnecessary deaths each and every year in the UK because the NHS fails to match the best health outcomes from around the world. Even compared against the 12th best, the figure is 17,000 avoidable deaths.
International comparisons are complex, and we wanted to measure health outcomes related to the health system, rather than a country’s economy, culture, diet, etc. So the report looks at five year survival rates for the most common cancers in the UK. You either have cancer or you don’t, and it will largely be the health system that determines survival rates. (We also consider strokes, respiratory diseases, and other health system indicators such as waiting times, diagnostics, spending and efficiency.)
We compare with the 12th best to avoid accusations of a stitch up, and to avoid anomalies or outliers. But using the survival rates of each condition from the 12th best performing country, and applying those to our own mortality rates, we have learnt that:
- 2,500 people die of breast cancer who would not have died if they lived in Belgium.
- 3,200 die each year from bowel cancer who would not have died if they lived in the Netherlands.
- 3,000 die from a stroke who would not have died if they lived in Switzerland.
And this list goes on. It is also concerning is that the UK ranks 30th on lung cancer survival rates and 29th on stomach cancer.
On many conditions, the UK is out stripped by countries that we might expect to outperform us, such as Japan, Singapore, or Switzerland. But we are also out performed by countries that we might hope to do as well as, or better than, such as Belgium, Canada, Denmark, France, Iceland, Malta, the Netherlands, and Sweden. And we are also outranked in a variety of conditions by countries that may come as a surprise, such as Chile, the Czech Republic, Estonia, Latvia, Poland, Slovakia, Slovenia, and Turkey.
Some people reading this may think: “The NHS just needs more money. Then it will be fine.” Yet spending cannot be the sole reason for our poor performance. The report clearly shows that there are countries who spend less than or close to the same as we do on health care as a percentage of their GDP – Australia, Finland and Israel for example – yet still outperform us on various conditions.
Other people may suggest that some specific reform would improve the NHS. But these responses highlight the fundamental problem when it comes to talking about the system – the lack of openness to examples, models, practice and evidence available from other countries.People think you can have either the NHS or the US private healthcare system – implying that the UK is alone in having universal healthcare.
It is time to blow this thinking open, because these misunderstandings prevent us from thinking about how we can actually improve health outcomes.With over 25 countries in the world with universal health coverage – with the United States not among them – there are plenty of lessons to learn that could be applied to the UK health system.
So I call on the Government to set up an urgent inquiry to examine the poor performance of the NHS compared to the rest of the world, and to identify lessons that can be learnt on funding and delivery of the UK health service. In the meantime, UK 2020 intends to set up a commission to look at what lessons can be learnt from those dozens of countries that outperform us in our most prevalent diseases.
These are depressing statistics for anyone to hear, let alone for the 1.5 million people who work within the NHS with such dedication. But it is surely for them, as much as for the health of our citizens who so depend on our health service, that we must have a truly open discussion about the NHS in which no ideas are off limits.
Owen Paterson will be giving a speech about the report later today. Details here.