3 July 2015

The UK can and should do better in preventing unnecessary hospital admissions and improving survival from some of the biggest killer diseases, a new report comparing performance across high-income countries reveals today. 

Focus on: international comparisons of healthcare quality, published by the Nuffield Trust and the Health Foundation, is one of the most comprehensive studies yet to compare the quality of care in the UK health system with that of similar countries over time. It shows that the UK’s performance has improved on almost every measure since the start of the millennium. However, it also finds that the UK lags behind most other countries (where data are available) in several areas of care, including higher rates of preventable hospital admissions, lower cancer survival and higher mortality rates from heart attacks and strokes. 

The report is based on analysis of 27 care quality indicators in up to 15 OECD countries between 2000 and the last year for which data are comparable (usually 2011 or 2012). The indicators examined present a broad look at health system performance across primary care, hospital care and highly specialist care, such as for cancer. Taken together they offer a starting point for much-needed work to understand better the reasons for variation between countries. 

Key findings include: 

  • The UK performs better than other countries in achieving high flu vaccination rates and lower antibiotic prescribing rates, suggesting a well-functioning primary care system. But rates of potentially preventable hospital admissions for chronic respiratory conditions, including asthma and lung diseases, remain relatively high in the UK (for example, by 2011 there were 61 UK admissions for asthma per 100,000 population, compared to 13.6 in Canada and 11.4 in Italy).
  • The UK has made headway in reducing mortality from heart attacks in recent years, but still lags behind the five other countries where data are available, with 10 percent of people over the age of 45 dying after 30 days compared to 8.2 percent in Norway, 8.4 percent in New Zealand, and 8.5 percent in Sweden in 2011. 
  • The UK reports excellent performance on cancer screening, with over three-quarters of 50-69 year old women being screened for breast cancer over the period, compared to fewer than 60% in Australia. Cervical screening rates are also high, although have recently deteriorated in the UK. 
  • However, the UK lags behind other countries on survival rates for common cancers: between 2007 and 2012 82% of women survived over five years for breast cancer, compared to 87.4% in Sweden. The UK’s five year survival rates for cervical and bowel cancers were also worse than other countries, and overall mortality rates remain higher than comparable countries. 
  • The UK has recently made good progress in narrowing the performance gap on mortality from common strokes caused by a blood clot, but still performs less well than most other countries where data are available. For rarer strokes, caused by a bleed in the brain, the gap with the best performer (Sweden) has remained persistently high, but the authors say that routine international data on strokes can be problematic because of variations in how countries collect the data. 

While the authors point out the value in using international data to ask better questions about the quality of health services, they warn that data limitations make meaningful comparisons difficult. They caution against rankings or league tables focused on data at a single point in time, highlighting the value in longitudinal studies such as this one. The report also notes that national level data will often mask considerable variations within countries, and emphasises that the level of performance on care quality indicators is also due to factors not within the control of healthcare systems, such as lifestyle choices and population health. 

Commenting on the report, Nuffield Trust Chief Executive Nigel Edwards said:

“Interpreting international data on healthcare systems is notoriously tricky, and any comparisons 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. It is also worrying that a UK citizen appears to have a significantly lower chance of surviving a heart attack than a Scandinavian one. 

“In spite of some positive findings in other studies, such as last year’s report from the Commonwealth Fund, it is still the case that on some important indicators there is significant room for improvement. 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.” 

Dr Jennifer Dixon, Chief Executive of the Health Foundation, said: 

 “This research is encouraging –improvements in the quality of care are being made in the UK across a range of areas. For example in cancer screening, with over three-quarters of 50-69 year olds being tested for breast cancer between 2000 and 2012.  But there are obvious areas where the UK lags behind other countries - survival from breast, bowel and cervical cancer and survival after a heart attack. To make progress, we need much more probing as to why, and what we can learn from how care is organised in other countries.”

The analysis also considers emergent indicators on mental health, safety and patient experience, highlighting the need for more consistent data on these measures. The authors urge Government to support efforts to improve international data collection in order to develop a more comprehensive set of comparative indicators across all areas of healthcare and encourage policymakers to act to understand the reasons behind the gaps between the UK’s performance and that of other countries. 

Notes to editors

  • Focus on: international comparisons of healthcare quality is by Lucia Kossarova, Ian Blunt (both senior research analysts at the Nuffield Trust) and Martin Bardsley, the Nuffield Trust’s Director of Research. It is published as part of the Nuffield Trust and Health Foundation’s QualityWatch programme, exploring how the quality of care is changing over time. For more information  on QualityWatch visit www.qualitywatch.org.uk 
  • The report focuses solely on the quality of care in comparator countries and not on other factors like staffing or funding. However, it notes that the UK spends significantly less as a proportion of GDP on healthcare than most of the 14 comparator countries. 
  • The report builds on work from the Nuffield Trust in 2008 and authored by Shelia Leatherman looking at international healthcare indicators. Since then, the OECD’s Health Care Quality Indicators (HCQI) project started, which compiles healthcare data across member countries.  
  • The Nuffield Trust is an authoritative and independent source of evidence-based research and policy analysis for improving health care in the UK. It conducts cutting edge research and influential analysis, informs and generates debate, supports leaders, and examines international best practice.
  • The Health Foundation is an independent charity working to improve the quality of healthcare in the UK.  It exists to support people working in healthcare practice and policy to make lasting improvements to health services. The Health Foundation carries out research and in-depth policy analysis, runs improvement programmes to put ideas into practice in the NHS, supports and develops leaders and shares evidence to encourage wider change. 

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