31 July 2018

Jessica Morris

Research Analyst
Nuffield Trust

International comparisons of the performance of health systems can be a powerful tool. As well as highlighting areas for quality improvement, they enable us to answer big questions like ‘How good is the NHS?’.

The Government’s mandate to NHS England for 2018-19 describes an ambition for the NHS in England to “offer all its citizens the safest, most compassionate, highest quality healthcare in the world”. Although there are many challenges in collecting high-quality and comparable data across countries (such as differences in data collection which can bias the results), comparisons are important as they are a means of understanding how the UK is progressing over time relative to other countries.

This month we updated our international indicators, drawing on data from the Organisation for Economic Co-operation and Development (OECD), the Commonwealth Fund and the Global Burden of Disease Study.

Mortality amenable to healthcare

  • In 2015, the UK’s amenable mortality rate (deaths that could have been avoided in the presence of optimal quality healthcare) was 70 deaths per 100,000. This is higher than 12 of the comparator countries, including Spain, France and Australia, although rates for most countries are converging.

Potentially preventable emergency hospital admissions

  • In the UK, the age-sex standardised COPD hospital admission rate is relatively high compared to other OECD countries, and the hospital admission rate for asthma is the highest of all the comparator countries apart from the United States.
  • In contrast, between 2011 and 2015 the hospital admission rate for diabetes in the UK was stable at 73 admissions per 100,000 population, which is one of the lowest rates compared to other OECD countries.

Preventable risk factors

  • Daily smoking has decreased in most OECD countries since 2000. In the UK, the proportion of the population aged 15+ who are daily smokers decreased from 27% in 2000 to 16% in 2016. This is the third largest decrease of the comparator countries.
  • Obesity has been rising in most OECD countries over the past two decades. In the UK, the proportion of the total population who are obese increased from 21% in 2000 to 26% in 2016. Japan consistently has very low levels of obesity. In 2016, 40% of the total population in the United States were obese.
  • In the UK, alcohol consumption decreased from 10.4 litres per capita in 2000 to 9.5 litres per capita in 2016, which is just above the average of the comparator countries. Greece has the lowest alcohol consumption and France has the highest.

Antibiotic prescribing

  • Between 2000 and 2014, the volume of antibiotics prescribed in the UK increased from 14 to 20 defined daily doses (DDDs) per 1,000 inhabitants per day. Since then, the volume has decreased to 19 DDDs per 1,000 inhabitants per day in 2016. The UK prescribes fewer antibiotics in primary care than France, Italy and Spain, but more than the Netherlands, Sweden and Germany.
  • In the UK, the proportion of antibiotics prescribed that were cephalosporins or quinolones (second-line antibiotics that are restricted for situations when first-line antibiotics have failed) decreased from 8.6% in 2007 to 3.8% in 2012, and has since remained broadly stable, reaching 3.5% in 2016. The UK performs the second best out of the comparator countries, with only Denmark having a lower proportion.

Adult flu vaccination coverage

  • Between 2000 and 2016, the UK had some of the highest levels of influenza vaccination coverage amongst over -65 -year -olds compared to other OECD countries. In 2016, 70.5% of the population aged 65 and over were immunised.

Breast and cervical cancer screening

  • In the UK, breast screening coverage has remained relatively steady over time with an average of 76%. While the UK outperforms many OECD countries including France and Germany, breast screening coverage is higher in the Netherlands and Finland.
  • Compared to other countries, the UK has one of the highest cervical cancer screening rates. However, there has been a gradual decrease in the proportion of women screened over time from 84% in 2000 to 77% in 2016.

Cancer survival rates

  • Five-year survival for breast cancer has been improving in the UK over time, reaching 86% in 2010-2014. However, the UK lags behind several other OECD countries. The United States had the highest five-year breast cancer survival rate, reaching 90% in 2010-2014.
  • While cervical cancer survival has been improving in the UK, the country is still one of the worst performers compared to other OECD countries, with a five-year survival of only 64% in 2010-2014.
  • The five-year colon cancer survival rate in the UK has also been increasing over time, but in 2010-2014 survival reached only 60%. This is the lowest survival rate of the 18 OECD countries that we included.

Cancer mortality rates

  • Breast cancer mortality has been declining in the UK, falling from 38 deaths per 100,000 women in 2001 to 28 deaths per 100,000 women in 2015. However, the UK consistently has a relatively high breast cancer mortality rate compared to other countries.
  • In 2001 the UK had one of the highest cervical cancer mortality rates of all the comparator countries, but by 2015 the UK's ranking had improved.
  • Colorectal cancer mortality has been slowly decreasing over time in the UK, falling from 26 deaths per 100,000 population in 2001 to 22 deaths per 100,000 population in 2015. The UK's performance is about average within the comparator countries.

Stroke and heart attack mortality

  • In the UK, 30-day mortality after admission to hospital for ischaemic stroke decreased rapidly from 17 per 100 patients in 2008 to 11 per 100 patients in 2013. However, rates have subsequently plateaued and remain higher than most of the comparator countries.
  • Between 2008 and 2015, 30-day mortality after admission to hospital for acute myocardial infarction (or heart attack) in the UK decreased from 12 per 100 patients to 8.8 per 100 patients, but this is still slightly higher than most of the comparator countries.

Mental health outcomes

  • Internationally comparative data on the quality of mental health care is limited, but we were able to draw on OECD data relating to suicide rates.
  • The UK consistently has a low rate of inpatient suicide. Between 2012 and 2015, the UK's inpatient suicide rate was the lowest of the comparator countries at 0.1 per 1,000 patients.
  • The UK's suicide rate within 30 days of discharge among patients diagnosed with a mental disorder is consistently lower than comparator countries for which there is available data.

Infant and neonatal mortality

  • Infant and neonatal mortality rates have been decreasing in most OECD countries since 2000.
  • The UK has a relatively high rate of infant mortality compared to other countries, with 3.9 infant deaths per 1,000 live births in 2016.
  • The UK’s neonatal mortality rate is also higher than many other countries, increasing slightly to 2.8 neonatal deaths per 1,000 live births in 2016. This is the same as was recorded for Greece.

Low birth weight

  • In 2016, 6.9% of all live births in the UK weighed less than 2,500 grams. Compared with other countries, the UK lies around the middle of the range of values. The Scandinavian countries tend to perform best on this measure.


  • The proportion of babies who are breastfed, at least partially, when they are 6 months of age is relatively low in the UK compared to other European countries. In 2010, 34% of babies in the UK were breastfed at 6 months compared to 63% of babies in Sweden.

Vaccination coverage for children

  • The UK’s diphtheria, tetanus and pertussis (DTP) vaccination coverage has increased over time, from 91% in 2000 to 96% in 2015.
  • Between 2000 and 2004, the UK’s vaccination coverage for measles declined, falling from 88% to 81% over this period. Since then the coverage rate has recovered, reaching 95% in 2015.

Do patients feel involved in decisions about their care?

  • The OECD found that UK patients are more likely than average to report that their regular doctor involved them in decisions about care or treatment, but this declined slightly from 91% in 2010 to 89% in 2016.

Venous thromboembolism

  • The post-operative deep vein thrombosis (DVT) rate after hip or knee replacement surgery is relatively low in the UK compared to other countries. Between 2011 and 2015, the post-operative DVT rate decreased from 240 to 202 per 100,000 hospital discharges. This is much lower than France’s rate of 1,328 per 100,000 hospital discharges in 2015.

For as many indicators as possible, we drew comparisons between the UK and 18 other countries: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, Netherlands, New Zealand, Portugal, Spain, Sweden and the United States. For more information, and to view the interactive charts, please visit the QualityWatch indicator pages.


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