July 12, 2010 • 11:00 pm
Health Secretary Andrew Lansley caused quite a stir with his announcement of a White Paper to reform the NHS.

The proposals to give GPs greater control have drawn praise and criticism in almost equal measure.

The reforms, the Health Secretary claimed, were badly needed because the ramping up of NHS funding under Labour had failed to produce a resultant improvement in health outcomes.

The Claim

Speaking on the Andrew Marr Show over the weekend Mr Lansley said: “We do now spend the average of European expenditure on health, but we don’t get a European level of outcomes.”

So what outcomes was he talking about, do the figures back him up, and is this necessarily the best way to judge the NHS against the healthcare systems enjoyed by our European brethren?


Full Fact contacted the Department of Health for clarification of the Health Secretary’s statement.

We were told that the main outcomes Mr Lansley was referring to were survival rates for cancer and mortality rates for strokes.

The department supplied us with data for both areas, which suggest that the Health Secretary’s claim around health outcomes was accurate.

The cancer survival claim is based on data compiled by Eurocare, which suggests that the UK lags behind other European countries in terms of five year cancer survival rates.

However Full Fact has previously encountered problems in using the Eurocare data for international comparisons.

In fact-checking the televised leaders debates, we noted how scientists writing in the Lancet as well as campaigners at Cancer Research UK, warned that the comparisons of survival rates compiled by Eurocare were not complete enough to be used for political purposes.

For stroke mortality rates, data from the World Health Organisation (WHO) shows that in 2004 the UK death rate for cerebrovascular disease was 45.6 per 100,000 while the average of the EU15 was 45.4 and the rate in France was 27.9.

But do concerns about cancer survival rate comparisons also apply to claims around stroke death rates?

Full Fact spoke to the WHO’s Colin Mathers, who told us that such comparisons were valid if rudimentary

“Certainly as a very crude comparator you could look at whether stroke death rates are higher or lower as a starting point but it wouldn’t necessarily tell you whether it was due to a health service treating people or more to do with primary prevention,” he said.

So are these survival and mortality rates necessarily upon which Mr Lansley basis his claim the best benchmark of how the NHS compares on the world stage?

Full Fact spoke to Vidhya Alakeson, Senior Research Fellow at the Nuffield Trust, who flagged up potential limitations of using international comparisons, such as those from the WHO.

She said: “A lot of what they are looking at is not actually what the impacts of healthcare are but social determinants of health, large parts of which aren’t amenable to change by healthcare systems.

“So there is increasingly more work being undertaken to look at conditions that are amenable to healthcare where a good, well-functioning healthcare system would make the difference rather than, say, better housing, lower poverty or a more equal society.”

She added that this was an important distinction because it was not clear whether countries that come out on top in such comparisons would still score highly conditions that are amenable to healthcare were taken into account.

Mr Mathers also accepted that there was a trade off between the narrow indicators used by Mr Lansley and attempts to get a broader picture of the relative success of healthcare in different countries.

He said: “Certainly people are looking at a broad range of indicators but of course it becomes harder to boil down to a summary of whether one system is better than another.”

Given these points it is worth asking whether the comparison Mr Lansley made between spending levels and survival rates is particularly illustrative.

WHO figures show that total UK expenditure on health rose from 7.1 per cent of GDP in 2000 to 8.2 per cent in 2006, while for Europe as a region the figure rose from 8 per cent to 8.4 per cent.

However Ms Alakeson told us that despite the claim that our health service compared badly with other European countries when spending and outcomes were considered together, the NHS did in relative terms deliver a degree of value for money.

“The NHS is relatively low-cost compared to other European systems, so from a value for money perspective it looks better than if you just look at outcomes,” she argued.


Our investigation shows Andrew Lansley’s figures are broadly accurate. However there are important points that must be kept in mind.

Health experts that we have spoken to suggest that there are pitfalls in drawing too broad conclusions from the rather narrow points of comparisons.

Indeed the research published in the British Journal of Cancer, which is cited by the Department of Health, on the lives that could be saved by delivering European levels of outcomes in cancer survival warns of a “lack of direct comparative data enabling definitive statements to be made on the reasons for survival differences between countries and on the numbers of lives that might be saved through different interventions.”

Given the apparent limitations of the international comparisons of healthcare systems, it will be interesting to see if they are the yardstick by which Mr Lansley ultimately judges his own reforms.

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