How does the NHS compare internationally on disease mortality?

With the NHS Bill now reaching the end of its pause period, and with the Government indicating that substantial changes will be made, Full Fact has been taking a closer look at the claims being made in this important debate.

When a Full Fact reader got in touch with us regarding claims made by Health Secretary Andrew Lansley on how the NHS ranks internationally, we set out to investigate.

In a statement on the Health Bill, Andrew Lansley stated that: "The NHS today faces great challenges... It does not deliver outcomes in line with the best health services internationally — many of our survival rates for disease are worse than those of our neighbours."

In this case, the data that is referred to on disease survival rates was also used in the White Paper on the Bill: 'Equity and Excellence — Liberating the NHS'. 

It states that: "Compared to other countries, however, the NHS has achieved relatively poor outcomes in some areas. For example, rates of mortality amenable to healthcare, rates of mortality from some respiratory diseases and some cancers, and some measures of stroke have been amongst the worst in the developed world. In part this is due to differences in underlying risk factors, which is why we need to re-focus on public health. But international evidence also shows we have much further to go on managing care more effectively. For example, the NHS has high rates of acute complications of diabetes and avoidable asthma admissions; the incidence of MRSA infection has been worse than the European average; and venous thromboembolism [blood clots] causes 25,000 avoidable deaths each year."

For the first comparison, an academic paper looking at the relative rates of mortality amenable to healthcare in different counties was referenced by the Health Bill White Paper. Using data on OECD countries from the 2000 World Health Report the report sought to "assess whether and how the rankings of the world's health systems based on disability adjusted life expectancy as done in the 2000 World Health Report change when using the narrower concept of mortality amenable to health care, an outcome more closely linked to health system performance."

The UK performed badly in international ranking under this comparison, coming much lower than in the 2000 World Health Report. However, the report is extremely cautious about viewing this analysis as a stand-alone ranking. They point out that other methods of comparison produce different results, and that the data available for making international comparisons is often not comprehensive. It is also important to keep in mind that this was a report based upon data from 2000.

Looking at the claims on respiratory disease and some cancers, the White Paper cites Eurocare figures and analysis across European countries. Eurocare produces a wealth of data and analysis for cancer treatment and survival rates in Europe; and a recent analysis of data on the 5 year survival rate for cancers diagnosed between 1995-1999 shows that UK performance varies across cancer types. While the UK has relatively poor survival rates for some cancers, it has a higher success rate for others. 

Cancer Research UK has also warned that the Eurocare data for some of our international peers is patchy "making comparisons difficult."

The comparison for stroke survival dates comes from an OECD Health at a Glance 2009 report, which ranks the United Kingdom at the bottom for 30 day mortality rates following a stroke. The points on diabetes and asthma also come from this OECD report. 

Data from the European Centre for Disease Prevention and Control is cited for MRSA. We looked at their 2009 surveillance report which shows that UK MRSA incidence rates in 2009 are slightly below average, having declined year-on-year since 2006 from one of the highest European levels. 

Finally, the question of venous thromboembolism was addressed by the House of Commons Health Committee, which goes into extensive detail on the question of the 25,000 annual deaths attributed to these blood clots. 

Conclusion

Taking a step by step analysis of the White Paper claims on how the NHS compares internationally on disease survival rates shows that all of the factual comparisons being made do match what is being said in the available figures and research, although some of the data is incomplete. 

However, the debate on how the NHS compares internationally clearly cannot be concluded by showing that the examples of points of comparison analysed above are broadly accurate. All of the reports above are extremely detailed and extensive, with data covering a wide range of diseases and health issues, in which the UK's performance is variable — from very good to very bad. Focusing solely on the negative outcomes may therefore be a bit of a selective analysis.