No Need to Flinch: A Comparative Review of the Condition of the NHS

Our report published in 2010, On Borrowed Time, projected fiscal distress for the UK along Irish lines unless we transform public services. The biggest single burden on the public purse is the NHS, where the government’s proposals for reform have given rise to the typical protests. In this paper, we ask whether it makes sense to refrain from reforming healthcare to avoid disrupting a regime that delivers distinguished results, as suggested by the King’s Fund. To do so, we have analysed data from the World health statistics published by the World Health Organisation. We find that the evidence:

  • Fails to show that the NHS itself demonstrates either distinguished health outcomes or value for money. Ranked against similar countries, the UK is in the bottom half on all such scores.
  • Contradicts claims that sharing burdens across society helps healthcare results, which are at least three times more related to healthcare spend per capita than healthcare spend as a proportion of GDP. This reminds us that if we want healthcare, we need to aim for economic prosperity.
  • Shows that insurances are more present in outperforming than underperforming healthcare regimes. The proportion of expenditure sourced from insurances by outperformers is nearly 300 basis points above the figure for the underperformers. This means that insurances schemes are no bar to satisfactory healthcare results.
  • Implies that healthcare outcomes are far more consistent with private than with public expenditure. Health outcomes are at least one hundred times more related to private expenditure than to public expenditure; indeed public expenditure is virtually unrelated to outcome. In other words, the most salient feature of the NHS stands in the way of healthcare outcomes not just in the UK but throughout the developed world.
  • Reveals that the national affection for the NHS’s defining features is supported only by data having nothing to do with the UK’s current state: no such data can be found in the panel of comparable countries, occurring only in the global figures which bring in irrelevant data.

We conclude that nothing in the data implies that the NHS should not be reformed. To the contrary, the figures argue that transformation is urgently needed, with the risk of disruption outweighed by the potential for improved healthcare performance following transformation

Read this report.