Is poor NHS care killing 2,000 children a year?

Published: 30th Sep 2013

"Poor NHS care 'kills 2,000 children'"

Sunday Times, 29 September 2013

As if it hasn't been a bad enough year for the NHS, readers of yesterday's Sunday Times were told that the much-loved service now has the lives of 2,000 children on its conscience. 

The claim itself is attributed to the Royal College of Paediatrics and Child Health (RCPCH), which recently issued a report looking into child mortailty in the UK, specifically on young people with epilepsy. However, their version wasn't so damming to name the NHS specifically:

"The United Kingdom has the worst levels of child mortality in Western Europe. Compared to Sweden, which is the best performer, it has been estimated that there are almost 2,000 excess child deaths a year; that's an average of five a day."

In fact, far from suggesting the NHS is the killer, the next line continues:

"Of course, not all these excess deaths are from healthcare amenable conditions, so it is essential that we gain a more detailed understanding of the heterogeneous factors underlying our relatively poor performance."

In fact the RCPCH isn't the original source anyway. It cites a report published in the Lancet journal earlier this year: 'Health services for children in western Europe', which analysed World Health Organisation mortality statistics for different european countries, gathered on a national level like those published by our Office for National Statistics.

Looking again at the report, the exact nature of the claim is made explicit:

"If all countries in the EU15 [Sweden, Luxembourg, Finland, Spain, Greece, Germany, Italy, France, Austria, Ireland, Netherlands, Portugal, Denmark, Belgium and the UK] could reduce their child mortality to that of Sweden (the best-performing country), more than 6,000 excess deaths could have been prevented in 2010."

The UK's share of that being 1,951 deaths in excess of Sweden over the course of a year. That's the difference between about 29 child deaths per 100,000 children compared to about 48.

So we're not dealing with 2,000 proven cases where we know the NHS has provided poor care and caused the deaths of children. Instead, 2,000 is roughly the number of lives that wouldn't have been lost had the UK's mortality rates been as good as Europe's lowest.

So are we doing something wrong, and can we put it right?

This is a more open question, although the Lancet authors state further that as far as reaching Sweden's standard goes, "This goal is achievable." However, they don't present bridging this gap as a task for healthcare alone.

They suggest, for instance, that countries which spend more on social protection for families (such as benefits and tax credits) tend to have lower rates of child death.

Data from Eurostat confirms there's some correlation on this front, although this alone is a long way off proving anything about how to cure excess child deaths. And the paper itself concedes it can't account for "social and cultural factors implicated in causation and devising of solutions". 

This isn't to say the NHS doesn't have its part to play. The research is explicit on the differences it perceives between the UK and Sweden when it comes to paediatric care.

For instance, according to the research most GPs in Sweden are supposed to receive three months' specialist training in paediatrics, unlike in the UK where GPs might not have training beyond undergraduate level.

So to say the figures show poor NHS care kills 2,000 children a year isn't a fair representation of the data that's available. Instead, 2,000 is roughly the number of lives which would be saved if the UK's child mortality indicators were in line with Europe's lowest - in Sweden.

Even if the UK were to come in line with Europe's average, on this scale this would mean around 1,000 fewer deaths.

The authors of the study behind this state that a range of factors that go well beyond healthcare provision are behind the discrepancy between the UK and Sweden, although they're confident the gap can be bridged. 

Flickr image courtesy of estherase.


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