The latest edition of Health at a glance, the Organisation for Economic Co-operation and Development’s biennial evaluation of the performance of health systems in OECD countries, extends its usual remit by assessing the impact of ‘the most important health crisis since the 1918 influenza pandemic’.
The Covid-19 pandemic
The adoption of unprecedented measures to control the Covid-19 pandemic, the adaptation of health and care services to deal with the ensuing pressures, the deployment of IT, and the remarkable speed of vaccine roll-out are common to much of the high-income world. Many of the impacts on people’s health are also common, notably the successive waves of infection; the devastating death toll; the pandemic’s unequal impact on different population sub-groups; the indirect impacts such as significantly reduced use of and disruption to health care for non-Covid-19 conditions, eg, cancer; the mounting backlog of care and number of people with undiagnosed disease; and the deterioration in people’s mental health. So, the United Kingdom is not alone in these respects.
The impact on mortality
Excess deaths in the United Kingdom from January 2020 to June 2021 were higher than in most West European and high-income countries except for Spain, Portugal, Italy and the United States.
The OECD doesn’t compare ‘performance’ in pandemic-handling between countries directly because of the different ways of counting infections, deaths, etc, and because the pandemic is still playing out. However, the number of excess deaths1 and changes in life expectancy provide an indication (see Figures 1, 2 and 3). Excess deaths in the United Kingdom from January 2020 to June 2021 were higher than in most West European and high-income countries except for Spain, Portugal, Italy and the United States. While life expectancy fell in 2020 in all but a handful of OECD countries, the greatest falls were in Spain, Italy, Belgium, the United States and the United Kingdom (and some East European countries, where life expectancy has always been much lower than in the United Kingdom). This doesn’t augur well for the United Kingdom: its pre-pandemic life expectancy was lower than in many comparator countries (except the United States), especially for females, and it experienced among the lowest gains in the preceding decade.
Moreover, the outlook suggests the UK’s life expectancy will not bounce back in 2021. Covid-19 infections and admissions in the UK have recently been running higher than in many European comparators – possible contributory factors being the relaxation of restrictions, waning immunity following UK’s earlier roll-out of vaccinations, and lower vaccination rates among children compared with some European countries. Compared with 75,000 excess deaths in 2020 relative to the 2015–19 period, there have already been more than 42,000 excess deaths in England and Wales during January–October 2021, with more to come.
Health care quality
Health at a glance’s comparative data on other health outcomes and on health care quality in pre-pandemic 2019 shows, as in previous years, the UK picture is mixed. For example, it compares relatively poorly on obesity, levels of exercise and mortality from heart disease and cancer. The 24 per cent cut in England's real-term per capita spending on public health since 2015/16 therefore urgently needs to be reversed. The United Kingdom also lags on cancer survival rates, case-fatality rates for heart disease and stroke, ‘avoidable’ mortality (ie, deaths potentially preventable or treatable by health care) and infant mortality. However, the UK's performance on flu vaccination, breast cancer screening, diabetes care, suicide following psychiatric admissions and prescribing of cheaper, generic drugs compares well. The OECD report comes on the back of another by The Commonwealth Fund, which examined pre-pandemic health care quality (eg, access, quality, outcomes) in 11 high-income countries: the United Kingdom ranked highest on affordability but only ninth on health care outcomes and fourth overall.
...the NHS is struggling to cope with the pandemic’s legacy which includes an exhausted workforce, a large and growing backlog of care and widening health inequalities.
Health care resources
A key strength of the NHS relative to many OECD countries is that it assures universal coverage and cost is not generally a barrier to access. However, a consistent refrain going back years is that the NHS is under-resourced relative to other high-performing health care systems. Although health spending rose sharply in response to the pandemic, the UK spend per capita has historically been lower than in many comparator OECD countries. From doctors and nurses, to diagnostic scanners, to hospital and long-term care beds for older people, the UK is a poor relation. This longstanding under-investment in staff and infrastructure meant that the United Kingdom entered the pandemic with an already over-stretched health and care system. As a result, the NHS is struggling to cope with the pandemic’s legacy which includes an exhausted workforce, a large and growing backlog of care and widening health inequalities.
The OECD statistics describe the grotesque toll of Covid-19 globally but are also testimony to the speed with which medical science and health systems responded to the pandemic in many countries. Even so, the OECD points to the weaknesses in preparedness, decisive action and response capacity for health emergencies in many OECD countries, and the absence of co-ordinated, global leadership. It warns of the possibility of long-lasting damage to people's physical and mental health resulting from the pandemic, and calls for investment to strengthen pandemic preparedness and broader system resilience.
As health systems globally strive to cope not just with the pandemic but also the backlog of unmet care and needs that have accrued, the United Kingdom is further on the back foot than most. The United Kingdom needs not just to make up lost ground created by years of under-investment, but to go the extra mile if it is to have world-class outcomes and be adequately prepared for future exigencies.