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December 2019

Health services ‘lagging behind’ other high income countries



The quality of UK health services seems to be slipping but improvements will require more spending on staff and long term care, say researchers.

While the NHS shows ‘pockets of good performance’, spending, patient safety, and population health are all average or below average, relative to ten other high income countries, according to a study in The BMJ.

UK and US researchers compared the UK health system with those of nine other high income countries, across seven key areas including spending, capacity, accessibility, quality, and health outcomes.

The results show that the UK spent the least per person on healthcare in 2017 ($3825 – £2955) compared with an average $5700 for all other countries studied, and healthcare spending is growing at lower levels.

Although the UK has comparable numbers of people over the age of 65, it spends less of its already low total healthcare expenditure on long term care.

When it comes to the healthcare workforce, the UK had among the highest proportion of foreign trained doctors (28.6%) and nurses (15%).

Despite this, the numbers of healthcare professionals (general practitioners, specialists, nurses) are some of the lowest of all countries studied (UK 2.8 doctors per 1000 population compared with 3.5 study average), and these numbers are declining.

Although several outcomes were poor, such as death rates for heart attack and stroke, the UK achieved lower than average rates of deep venous thrombosis after joint surgery and fewer healthcare associated infections.

However, maternal death in the UK was higher than average, and is increasing, while the numbers of preventable and treatable deaths were the third highest and highest respectively.


Papanicolas I, et al. BMJ 2019;367:l6326 https://www.bmj.com/content/367/bmj.l6326