How does the NHS compare internationally on its spending and key resources?

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Our new analysis of how the UK’s health resources compare with those in other countries found a consistent (albeit consistently concerning) trend: from doctors to MRI scanners, from hospital beds to nurses, the UK health system has fewer resources than other countries. In our full report we compared the UK to a basket of European and English-speaking countries. However even if you broaden the basket to all OECD countries, including east Asia and those with very different health systems such as the USA, a similar pattern emerges (Figure 1). 

As with all comparisons of this type there are some important caveats. There are problems in finding comparable data across countries – for example, some countries only provide data for doctors in active clinical practice while other countries also include doctors working as educators or researchers. There are also problems in interpreting the data – the UK has far fewer hospital beds per person than Japan, but that is in part because patients stay in hospital for much shorter periods on average in the UK (7 days) than Japan (29 days). A high level of CT and MRI scanners may also be intuitively appealing if you want to reduce waiting times for diagnostic scans, but an oversupply of this equipment could lead to overuse and overtreatment. A low level of resources may not always be unreservedly ‘bad’.

But even with these caveats firmly held in mind, a quick look across the health care resources of different countries highlights four issues worth considering.

First, a recent change in accounting definitions means the UK is now about average in how much it spends on health care, but this new definition has also introduced a substantial gulf between what we now report as health care spending, and what we would traditionally think this health care spending buys. The increase in spending that has shoved the UK up the international league table is largely due to reclassifying some elements of what would be considered social care spending in the UK (eg, support in activities of daily living such as support with eating, bathing and washing) as health care. Some large chunks of health care spending – such as capital spending on hospitals and IT – are now excluded from the new definition of health care spending. This emerging gulf means it is more important than ever to triangulate comparisons of health care spending with other measures of health care resources – such as staff numbers – to gain a fuller picture of how the UK is faring.  

Although no one would argue that the UK should make decisions about health care based solely on these international comparisons, the consistency with which the UK falls short of other countries’ health care resources is striking.

Second, although no one would argue that the UK should make decisions about health care based solely on these international comparisons, the consistency with which the UK falls short of other countries’ health care resources is striking. Eighteen years ago, a Prime Minister decided this was, in part, reason enough to stimulate a boom in health care spending. Yet despite considerable investment and improvements in health care services in the intervening years, we now once more find ourselves firmly lagging behind our neighbours on resources, and routinely missing the performance standards this additional domestic investment delivered. Dissatisfaction with the NHS is now at its highest level since 2007, and 86 per cent of people think the NHS has a major or severe funding problem.

Third, what gets measured matters, and sadly we know more about how we compare internationally on our number of MRI scanners than we do about activity in primary care, mental health spending or what our community services deliver. There is a risk that using international comparisons as a spur for greater investment will always benefit areas where we know we are falling further behind (such as acute bed capacity) and leave other under-resourced areas unfairly hidden. More focus is clearly needed to understand how we compare on these important services.

And finally, while it is helpful to understand how the UK’s resources compare with other countries, the ultimate purpose of a health care system is – of course – to use these beds, medicines and equipment efficiently to improve the health of local people. The work of Mark Britnell and Lord Darzi has shown the UK health system has both something to teach and something to learn in this regard. New approaches to sterilising surgical equipment in developing countries, building capacity in community care in Israel, or generating a pan-political consensus to introduce sugar taxes in Mexico suggest at least some of the answers to the wicked questions the UK is grappling with may currently reside overseas.

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