The UK has a better cervical screening programme than Sweden, so why are UK women less likely to survive cervical cancer?
A review by the Nuffield Trust think tank released today compares the NHS’s performance with the health services of 14 other developed countries.
Although it is not all bad news – the report finds that the UK is stable or improving on all but two of 27 indicators – there are a number of indicators on which the NHS is underperforming. They include:
Cancer survival rates
The UK has the highest cervical cancer screening coverage of all comparator countries, but the lowest five-year survival rate of all comparator countries. In Korea, the five-year survival rate reached 76.8 per cent in 2006-11, and 67.3 in Sweden in 2007-12; in the UK in 2007-12 it was just 60.9 per cent.
The UK also has one of the highest mortality rates for cervical cancer out of all comparator countries.
Nuffield suggests that this shows there are still delays in diagnosis despite the screening programme, as well as barriers to accessing timely and effective treatment.
The UK also has one of the highest mortality rates for breast cancer at 30.4 deaths per 100,000 women. There is a high incidence rate for breast cancer in the UK (95 per 100,000 women in 2012) when compared to other countries such as Spain (67.3 per 100,000 women).
Potentially avoidable hospital admissions
Ambulatory care sensitive conditions (ACSCs) are conditions where effective community care and case management can help prevent the need for hospital admission.
In England, potentially avoidable admissions for ACSCs make up one in every five emergency admissions. Three of the conditions most commonly reponsible for such admissions – asthma, diabetes and chronic obstructive pulmonary disease (COPD) – can, Nuffield says, be treated effectively at the primary care level.
But when compared with other countries, the UK has ‘relatively high’ rates of hospital admissions for both asthma and COPD; for asthma, the UK is one of the worst performers of all the comparator countries. Canada, the country with the lowest avoidable admissions rate for asthma has a rate of 13.6 admissions per 100,000; the UK has 60.8.
This could be down to a number of factors including GP shortages and long waiting times which mean the standard and accessibility of primary care is compromised.
The review also finds that ‘many adults but especially children do not receive the recommended care for diabetes’. Worryingly, it finds that many diabetes-related amputations in England could be prevented with targeted preventative services and access to high-quality footcare.
Stroke survival rates
In 2011, the UK had the second highest 30-day mortality rate for haemorrhagic stroke out of all comparator countries, with 33.7 deaths per 100 patients. Only New Zealand performed worse on this measure.
For ischaemic stroke (the more common type), UK 30-day mortality rates have been declining rapidly, falling from 17 per 100 patients in 2008 to 12.4 per 100 patients in 2011, but still remain above all other comparator countries except for New Zealand.
The review recognises attempts made to improve acute care for strokes through the introduction of a national audit system, but concludes that ‘mortality rates between the UK and the comparator countries is of some concern and needs to be understood and reduced further over the coming years’.
The Nuffield review also finds that the UK has a higher incidence of suicide among mental health patients, but due to a lack of data and variations in means of measuring standards says it is unable to present meaningful comparisons for this report. It adds that despite the enormous burden of mental health, it is still not a high priority in most OECD healthcare systems.
The review concludes:
“The NHS in the UK faces profound challenges over the term of the current parliament. Comparing the results delivered by the NHS with other similar systems represents a notable opportunity to identify innovations that could help to deliver the required efficiency savings over the next few years.
“However, if the lessons are not learned or the savings cannot be delivered, the secretary of state for Health may find that international comparisons are used to highlight an increasing gap between the UK and other countries.”
Ruby Stockham is a staff writer at Left Foot Forward. Follow her on Twitter
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