Survey ranks NHS #1 for efficiency, #2 overall


by Sunny Hundal    
10:16 am - June 6th 2011

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A major new report ranked the British NHS #1 for efficiency and effective care when compared to other developed countries.

The US report compares the quality and cost effectiveness of healthcare systems in seven major countries.

Overall, the NHS is ranked second.

The report also shows that the US is ranked last, even though it spends far more on healthcare.

via Richard Murphy, who adds:

But most of all what this report says is that the room for efficiency gains in the NHS looks to be incredibly small. Patient centred activity has already been reduced to save cost. Timeliness has been compromised a little to secure savings. Efficiency is already rated as the highest in these seven countries. That’s not surprising, the clear raw data shows that be the case. How, in that case, is the NHS going to deliver massive increases in efficiency in a system that is already operating at way above international standards?

We need to get real: the NHS is already delivering extraordinary value for money. Private sector alternatives are exceptionally expensive, as the US proves, with worse quality outcomes (as the table shows).

[Update, we reported earlier this was a new report but its from last year. Apologies for that]

On the subject of private involvement in the NHS, an article in the Daily Telegraph today by Max Pemberton shes more light.

The article says: ‘Private firms won’t offer the NHS value for money‘:

Strenuous efforts by academics such as Allyson Pollock, professor of public health research and policy at Queen Mary, University of London, to obtain the data relating to private-sector involvement has uncovered some horrendous examples of profligacy and waste.

It also provides the definitive answer that private-sector involvement haemorrhages cash out of the health-care system and does not improve patient care.
In a series of articles in the British Medical Journal, Professor Pollock has shown, for example, that £500?million of taxpayers’ money has been wasted on a flagship scheme to treat NHS patients in the private sector.

The whole article is an essential read for those advocating privatising the NHS further.

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About the author
Sunny Hundal is editor of LC. Also: on Twitter, at Pickled Politics and Guardian CIF.
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Story Filed Under: Health ,News

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Reader comments


1. Luis Enrique

that’s an interesting and important argument – the idea that there might not be as much scope for efficiency gains on the NHS as people imagine.

equally, what does the nature of healthcare delivery in the number 1 country, Holland, tell us?

http://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands

“Hospitals in the Netherlands are mostly privately run and not for profit”

This is excellent – hopefully the report will gain some wider media coverage and the notion that Lansley’s reforms are really about ‘efficiency’ and ‘saving money’ (and not, say, making a few quid for his campaign-backers) will be laughed out of the country.

Just a quick point, though – the authors of the report do note:

“Any attempt to assess the relative performance of countries has inherent limitations. These rankings … do not capture important dimensions of effectiveness or efficiency that might be obtained from medical records or administrative data.”

I’m very surprised the UK health system was in front of Germany’s.

4. the a&e charge nurse

This report would only matter if the proposed bill was being driven by evidence rather than ideology?
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353

Lansley’s recent utterances have demonstrated his breath taking ignorance on health stats – it seems clear to me privatisation is the preferred model of ALL the major parties in spite of the evidence, not because of it?

Luis @1, you’re not allowed to compare the NHS to systems that are better, only those that are worse.

The only people I see talking about the US system are NHS fetishists.

Sunny, this “major new report” was published a year ago in “June 2010″ according the front cover of the report.

It also doesn’t tell us much about the relative benefits of public/private systems,

Only seven countries are included and there is no obvious pattern. Canada’s NHS-style largely public system does nearly as badly as the US on the self-selected criteria on which the report is based. Australia, New Zealand, Germany and the Netherlands all have mixed systems to different degrees, as do the UK and US.

As to the criteria chosen, of the 74 benchmarks, 71 are process orientated and self-reported from and handful surveys conducted between 2007-2009. What insight we can draw about health policy from use of “computerized reminder notices” or “written guidelines for depression” scores I’m not sure. That your healthcare provider may have maimed you, but did it efficiently with excellent computer and quality assurance systems is not I think a patient-centred measure of success.

The data for the 3 outcome metrics (life expectancy, mortality and infant mortality), is from 2003 and 2006, and there isn’t much difference between the UK and US, except in infant mortality, where the UK is in equal 4th with Canada, with a similar score to New Zealand in 6th.

How useful ranks are in judging either process or outcomes on such a small dataset is also questionable. Small differences can mean very big differences on rank, and similarly very large problems can be masked by a one rank difference.

The central message though that the US system is not cheap or efficient is not exactly news. Although it is also a mixed system with expensive public care as well as expensive private care, contrary to the usual characterisation.

Nor though is that very relevant to the NHS debate, which is about moderate increases in opportunities for private and third sector provision, more in line with the other systems praised in this report, not adopting the US model it condemns.

So what was your point?

In response to @1

The Netherlands spends 30% more per person than the UK to get the better outcome.

UK life expectancy outcomes are pulled down by our high levels of income inequality with areas with pockets of high levels of poverty like around Glasgow with significantly higher mortality rates, and poor quality social care. A good health system can help as a band aid solution here but until the real issues are addressed there is little the NHS can do about long, healthy and productive lives.

Kevin

8. the a&e charge nurse

[6] “Nor though is that very relevant to the NHS debate, which is about moderate increases in opportunities for private and third sector provision” – yes, Andy & Co may have couched changes in these innocuous terms, but the bill will have far more profound changes in the longer term.

Oh, how we laughed when we learnt about the current “listening exercise” – Andy wants to hear from the little people it seems – maybe one or two of them could point out his tendency to misunderstand health stats.
http://www.dh.gov.uk/en/MediaCentre/DH_125865

As I say the standard of the evidence (and the sort of discussion you highlight above) is virtually irrelevant – these changes are driven by ideology.

9. Luis Enrique

Kevin,

that sounds sensible to me, and perhaps an argument for increasing our spending to Dutch levels. But doesn’t the fact that Holland gets good, equitable outcomes out of a system with (regulated) private insurance and private provision also shows us those things aren’t always bad?

Doh, you’re right, its a report from last year. I’ve updated the article to reflect that.

That said, these figures are still newer than Lansley’s claim that up to 5,000 year lives could be saved if NHS did cancer treatment differently!

Ritchie really ought to read reports before he starts orgasming over them.

“To measure efficiency, this report examines total national expenditures on health as a percent of gross domestic product (GDP), as well as the percent spent on health administration and insurance.”

Insurance being part of what is spent on health care and thus double counting.

Even if they haven’t been that blatantly stupid they’re still not including the fact that by counting the ost of insurance they’re counting the cost of raising the money to pay for everything. But in a non-insurance system, we’re not counting the cost of getting all the tax money to pay for everything.

And the deadweight costs of taxation are considerable…….

Oh, BTW, in terms out outcomes amenable to health care (which is what we should be measuring when we look at how good a health care system is) the NHs is next to last.

Long, healthy productive lives. Does this mean after a patient has used the NHS after an illness/accident or does it mean the general health of a society through diet and exercise?

I think Tim Worstal is reading it wrong.

13. Planeshift

“And the deadweight costs of taxation are considerable…….”

Oohhh look – its the sound of goalposts being moved.

Lets have a brief skim of the report. Where does the UK do best?

Somewhat surprisingly it is in ICT:

“U.K. physicians are most likely to report it is easy to print out a list of all their patients by diagnosis. This finding may reflect the major push made by the U.K. government to implement health information technology (IT)……The increased use of IT in the U.K. plays a large role in the country’s high score on the chronic care management indicators, as well as its performance on system aspects of preventive care delivery..”

Given that adoption of ICT is innovation, this finding somewhat demolishes your claim about the link between markets and innovation doesn’t it?

Lets see what else we are good at:

Efficiency – low levels of paperwork and administration (p12)
Equity (p15)

And what does it say we are really bad at?

Long healthy productive lives (p3)
Communication and engagement with doctor (p8)

The last one is the worst, with a whole series of measures indicating our relationships with health care professionals is crap. It would be tempting to blame this on daily mail style promotion of alternative medicine and reduced deference to doctors, but I suspect there is truth in the notion that GPs have no customer care skills. GPs probably should be doing a far better job of communicating and understanding their patients, and applying the basics of customer service. This does beg the question of why the fuck is Lansley proposing GPs – the people letting the system down – should take more control over the system, at the expense of the parts doing a good job?

The other aspect we are bad at is long healthy lives, as we develop more chronic conditions. But this is less to do with the health system, and more to do with lifestyle factors such as obesity, drinking etc.

In other words this report offers no evidence to support Lansley’s proposals, nor does it support Tim’s view that markets will increase innovation and keep costs down – we do better on these than countries with more market based systems. It does however suggest we need to improve customer service between doctors and patients – something a market system and real choice (i.e. not what lansley is proposing) could do if it was thought properly through. It also suggests we have a problem relating to lifestyle and chronic conditions, which we need to address through better public health programs to reduce smoking , drinking and burgers. Something libertarians have claimed is the nanny state.

So I’m not surprised the goalposts are being moved.

14. So Much For Subtlety

4. the a&e charge nurse – “This report would only matter if the proposed bill was being driven by evidence rather than ideology?”

Well that might be true if the report wasn’t being driven by ideology rather than evidence as well. What matters in a healthy care system? Well healthy outcomes for one thing. Look at that table again.

** Britain comes last in Patient-Centred Care. **

You know I tend to think that is very important.

** Britain comes second to last in Long Healthy Productive lives **

I tend to think that is important too.

So how does Britain rank so high? They do the usual medical trick and add a lot of ideologically-based considerations to make Britain look better. So what if Britain ranks second best in “equity”? Do we all want to die earlier than we have to just as long as we all suffer the same? It is free to the consumer. Of course it is going to rank high among costs to the consumer. But it is not free to the economy as a whole and it is an exercise in ideological axe grinding that determines this is so important.

Some of the others vary. Efficiency? Of course the NHS does not have to collect money from consumers. The Inland Revenue does that. So it looks a lot more efficient than it really is. Safe Care? Effective Care? We have no idea what these are. They may be good measures or they may be bumpf. I suspect the latter.

The bottom line is that we do not pay much directly for the NHS and we don’t get particularly good treatment. If you think that Socialism is the goal we should aim for and capitalism is evil, then you will, no doubt, like this system. If you think that good financial outcomes for doctors and nurses are the right goal, you will like the NHS too. If you think good medical outcomes for patients is the right goal, you won’t. YMMV.

15. the a&e charge nurse

[14] well, whatever your views about the NHS Lansley’s dreadful proposals will not improve health care one iota.

Remember the tories are lashing £3 billion on this dog’s dinner of a reform during a time of austerity (20% reduction on health spend).
The tories did not even have the confidence (or honesty) to announce such drastic measures in their pre-election manifesto – I wonder why?

These moves have been panned by all concerned (RCN, BMA, RCP)
http://www.guardian.co.uk/society/2010/nov/19/doctors-warned-expect-unrest-reforms
So much so that the government has paused to undertake (snorts) a “listening exercise” – why on earth couldn’t they have called it by it’s proper name, “a waste of money exercise”?

Time and again we here from the right wing press (led by the Fail) how bad the NHS is, but the likes of this simple table tends to suggest a very different story?
http://www.bmj.com/content/342/bmj.d566.full

Anyway, the NHS as we knew it will be soon by gone – let’s see who fares best, ordinary patients, or the fatcats (I know who my money is on).

16. Planeshift

“You know I tend to think that is very important”

Except the part of the NHS that scores weakest on this are GPs. So how exactly is giving GPs more power going to improve patient care?

Luis @9:

that sounds sensible to me, and perhaps an argument for increasing our spending to Dutch levels. But doesn’t the fact that Holland gets good, equitable outcomes out of a system with (regulated) private insurance and private provision also shows us those things aren’t always bad?

“Private” has never been the problem, to be honest. I have no problem at all with private hospitals, they frequently do provide better health care. The Netherlands is a good example.

But the key thing in your early quote is not ‘private’. It’s not-for-profit.

The problem with ‘private hospitals’ here is that ‘private’ is code for ‘profit-making’ in this context, as it is in the USA. That is and will always be a cluster-fuck waiting to happen. The Dutch system is good precisely because it couples the best thing about private hospitals (flexibility and capacity to tailor services to needs on a local an immediate basis) with the best thing about public healthcare (NOT-for-profit).


Reactions: Twitter, blogs
  1. Liberal Conspiracy

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  2. sunny hundal

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  3. Dr Eoin Clarke

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  4. thejamesdixon

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  5. Michael Bater

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  6. Brian Moylan

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  8. Malcolm Evison

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  9. News Unspun

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  11. Tom Moberly

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  12. Dr Fiona Bloomer

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  13. Andy Bean

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  14. Earls Barton Med Cen

    RT @brianfmoylan: RT @libcon: New survey ranks #NHS #1 for efficiency and effectiveness http://bit.ly/k7YMM1 #Lansley #nhsreforms

  15. Zoë Titchener

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  16. Christine Ottery

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  17. Ryan Bestford

    Liberal Conspiracy: Survey ranks NHS #1 for efficiency, #2 overall – http://bit.ly/mEKcPh

  18. Rune Isene

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  19. socratext

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  20. John Bye

    Comparative survey of developed countries ranks ranks the NHS #1 for efficiency and effectiveness http://bit.ly/k7YMM1 (via @RichardJMurphy)

  21. Jon Archer

    New US survey ranks NHS #1 for efficiency/effectiveness. you want it better? you'll have to pay more. #fb ..http://bit.ly/k7YMM1

  22. False Economy

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  23. Jonathan Lintern

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  24. Flo Fflach

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  25. Andrew Griffiths

    RT @libcon Survey ranks NHS #1 for efficiency, #2 overall | Liberal Conspiracy http://t.co/zVPmRdu #savetheNHS

  26. Lauren G

    Survey ranks NHS #1 for efficiency, #2 overall | Liberal Conspiracy http://t.co/nnFcn9W via @libcon // lol @ US scores #welovetheNHS

  27. Wikio UK

    (Liberal Conspiracy) Survey ranks NHS #1 for efficiency, #2 overall : http://wik.io/dP17y

  28. Helen H

    RT @libcon: Survey ranks NHS #1 for efficiency, #2 overall http://t.co/4te2elh

  29. Richard Forshaw

    The #nhs has been ranked 1st for efficiency, last for patient-centered care in a new report here http://tinyurl.com/5w9f3rj

  30. steve turner

    Comparative survey of developed countries ranks ranks the NHS #1 for efficiency and effectiveness http://bit.ly/k7YMM1 (via @RichardJMurphy)

  31. John Eldon

    RT @sunny_hundal: Comparative survey of developed countries ranks ranks the NHS #1 for efficiency and effectiveness http://bit.ly/k7YMM1

  32. SarahBoydHeudebourck

    The #nhs has been ranked 1st for efficiency, last for patient-centered care in a new report here http://tinyurl.com/5w9f3rj

  33. Matt McG

    http://bit.ly/lbFgOb

  34. Grahame Morris

    New survey ranks NHS #1 for efficiency and effectiveness via @libcon http://t.co/arnkGaW – Tell this to the Tories! #saveourNHS

  35. jo

    Survey ranks NHS #1 for efficiency, #2 overall | Liberal Conspiracy http://t.co/kEz2ZJN via @libcon

  36. Paul Marr

    Liberal Conspiracy: Survey ranks NHS #1 for efficiency, #2 overall – http://bit.ly/mEKcPh

  37. Tom Adams

    Comparative survey of developed countries ranks ranks the NHS #1 for efficiency and effectiveness http://bit.ly/k7YMM1 (via @RichardJMurphy)

  38. Tom Robins

    RT @libcon: New survey ranks NHS #1 for efficiency and effectiveness http://t.co/Dbbny1S

  39. natalieben

    Comparative survey of developed countries ranks ranks the NHS #1 for efficiency and effectiveness http://bit.ly/k7YMM1 (via @RichardJMurphy)

  40. 311 Fan

    Survey ranks NHS #1 for efficiency, #2 overall http://zite.to/lPRBkd via @Ziteapp

  41. Sam Liu

    Comparative survey of developed countries ranks ranks the NHS #1 for efficiency and effectiveness http://bit.ly/k7YMM1 (via @RichardJMurphy)

  42. Carolyn Anderson

    Survey ranks NHS #1 for efficiency, #2 overall | Liberal Conspiracy http://t.co/nH7jks1 via @libcon

  43. Greg Sheppard

    New survey ranks NHS #1 for efficiency and effectiveness http://bit.ly/k7YMM1

  44. Phil Range

    Survey ranks NHS #1 for efficiency, #2 overall http://zite.to/lPRBkd via @Ziteapp

  45. WillORNG

    RT @libcon: Survey ranks NHS #1 for efficiency, #2 overall http://t.co/A5Hy74t

  46. Oasis Caretaker

    Comparative survey of developed countries ranks ranks the NHS #1 for efficiency and effectiveness http://bit.ly/k7YMM1 (via @RichardJMurphy)

  47. Kevin Pritchard

    “@dickstar: #nhs 1st for efficiency, last for patient-centered care in new report http://t.co/t4lhMvL”< £20bn to come from where then???

  48. Staffordshire UNISON

    RT @libcon: New survey ranks NHS #1 for efficiency and effectiveness http://t.co/Dbbny1S

  49. Claire OT

    Comparative survey of developed countries ranks ranks the NHS #1 for efficiency and effectiveness http://bit.ly/k7YMM1 (via @RichardJMurphy)

  50. rb

    Survey ranks NHS #1 for efficiency, #2 overall: A major new report ranked the British NHS #1 for efficiency and … http://bit.ly/l6kGHN

  51. Tom Ashworth

    I still dont get why the NHS needs changing, David (http://is.gd/HX6keR); when you look at: http://bit.ly/jwauXf #facepalm

  52. Suparna Das

    The #nhs has been ranked 1st for efficiency, last for patient-centered care in a new report here http://tinyurl.com/5w9f3rj

  53. Jonathan Lintern

    @DanConservative Would you care to explain these stats, if the NHS is so wasteful? http://bit.ly/jwauXf

  54. Suparna Das

    “@dickstar: #nhs 1st for efficiency, last for patient-centered care in new report http://t.co/t4lhMvL”< £20bn to come from where then???

  55. Rosie

    Survey ranks NHS #1 for efficiency, #2 overall | Liberal Conspiracy http://t.co/hSmIZ4h via @libcon

  56. Nicky Lang

    Comparative survey of developed countries ranks ranks the NHS #1 for efficiency and effectiveness http://bit.ly/k7YMM1 (via @RichardJMurphy)

  57. James English

    NHS more efficient than you think, but 2nd in the World? #takethatcameron http://ow.ly/5aV19

  58. economicsnz

    A new survey shows NZ has nothing to learn from the US about health care. We do need to look to our laurels tho! http://is.gd/c8dxun #TPPA

  59. Brenda Wallace

    A new survey shows NZ has nothing to learn from the US about health care. We do need to look to our laurels tho! http://is.gd/c8dxun #TPPA

  60. gail simmons

    A new survey shows NZ has nothing to learn from the US about health care. We do need to look to our laurels tho! http://is.gd/c8dxun #TPPA

  61. Mel A

    A new survey shows NZ has nothing to learn from the US about health care. We do need to look to our laurels tho! http://is.gd/c8dxun #TPPA

  62. Mary Wellington

    A new survey shows NZ has nothing to learn from the US about health care. We do need to look to our laurels tho! http://is.gd/c8dxun #TPPA

  63. awkward orchid

    A new survey shows NZ has nothing to learn from the US about health care. We do need to look to our laurels tho! http://is.gd/c8dxun #TPPA

  64. Mike Campbell

    A new survey shows NZ has nothing to learn from the US about health care. We do need to look to our laurels tho! http://is.gd/c8dxun #TPPA

  65. Collen Chandler

    @philbeats its not haemorrhaging money! thats what Tories want u to think so they can privitise it. http://bit.ly/jb9Hmh hang in there bro x

  66. Collen Chandler

    @BabaOnos http://liberalconspiracy.org/2011/06/06/new-survey-ranks-nhs-1-for-efficiency-and-effectiveness/

  67. Sarah Law

    http://t.co/n4gSEo6u nhs wonderful!!!





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