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The NHS at 70: How good is the NHS?


The relationship between the public and the NHS is complex. Often described as ‘a national religion’, the NHS is the thing that makes people feel most proud to be British and regularly tops polling on the most important issues facing the country.

However, while many people strongly identify with its values, there is often debate about whether the service is sustainable in its current form. This complexity extends to people’s relationship with their own health, which is influenced by a range of factors, including genetic characteristics, behavioural factors and the environment in which they live. This complex interplay of factors raises the question of the extent to which people are responsible for their health or whether it is determined by factors beyond their control.

In this paper, we explore the public’s expectations of the NHS, the balance between meeting those expectations and living within a constrained budget, and the question of who is responsible for keeping us healthy.


This first, main report, How good is the NHS? uses OECD data and a range of other public sources to compare the NHS to health systems in 18 similar developed countries, including France, Germany, Italy, Japan and the USA. It looks at three aspects of what we might mean by a good health care system: the speed and accessibility of care, the efficiency of the system, and the outcomes delivered for patients. It also sets the scene by looking at what the health service has to work with, so that we can consider whether it is doing a good job given the circumstances.

The report finds that the NHS performs neither as well as its supporters sometimes claim nor as badly as its critics often allege. Compared with health systems in similar countries, it has some significant strengths but also some notable weaknesses.

Key strengths of the UK’s NHS include:

  • It provides unusually good financial protection to the public from the consequences of ill health. For example, it has the lowest proportion of people who skipped medicine due to cost (2.3% in 2016 compared to an average of 7.2% across the comparator countries).

  • It is relatively efficient: the UK has the largest share of generic prescribing of all comparator countries, at 84% in 2015 compared to an average of 50%.

  • It performs well in managing patients with some long-term conditions like diabetes and kidney diseases: fewer than one in a thousand people are admitted to hospital for diabetes in a given year, compared to over two in a thousand admitted in Austria or Germany.

Key weaknesses include:

  • The UK’s NHS performs worse than the average in the treatment of eight out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years.

  • It is the third-poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’).

  • It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): seven in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries.

Given limited or patchy data in certain areas and the inherent complexity of making comparisons internationally, this analysis does not provide us with the final word, but rather a set of issues to address as we look forward from the health service’s 70th birthday. The five reports we have produced look at some of the most important issues affecting its future. The NHS is a system set up to deliver the best care to everybody in the UK, and its staff believe deeply in this mission. The most fitting birthday present the service could receive would be a national discussion about how government, society and the public can work with it to realise this goal more successfully than ever.

The NHS at 70: other reports from this series