NHS reforms: How does the UK compare for stroke mortality?

The UK's poor performance compared to other developed countries for stroke mortality has been cited in the White Paper published by the Department of Health in 2010 as one of the reasons that the reforms in the Health and Social Care Bill were necessary.

The White Paper claimed that on some measures of stroke mortality, the UK has "amongst the worst in the developed world."

The OECD publishes data looking at at how member countries compare on stroke death rates, and indeed the UK does fare badly on some comparisons.

The table shown gives the fatality rates 30 days after admission for both ischemic and haemorrhagic strokes.

We also looked into the statistics at the time the White Paper was published, and this is what we found:

Data from the World Health Organisation (WHO) shows that in 2004 the UK death rate for cerebrovascular disease, (which can cause strokes) was 45.6 per 100,000 while the average of the EU15 was 45.4 and the rate in France was 27.9.

However international comparisons can be problematic, as seen in the debate over comparing cancer survival 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 solid grounds upon which Mr Lansley can best benchmark the performance of the NHS on the world stage?

We 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 if social factors were controlled for.

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.

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.

So while the data does suggest that the UK does not perform well compared to other countries in terms of stroke mortality, as with most international comparisons with health statistics, there are caveats that are worth keeping in mind.