In what seems like an annual ritual we are again told that the NHS is at breaking point as winter pressures of flu and Covid compounded with an ageing population and industrial action by doctors do their grim work. At the same time we hear that the UK spent 11.3% of its GDP on health in 2022 and is the 6th highest spender in the rich world and 4th highest spender in Europe. It is hard to reconcile these two sets of facts. Is the NHS failing? How can it be so bad apparently and yet so expensive?
Most of the health statistics we hear about, concerning waits at the front door of the service, are particularly susceptible to getting spectacularly out of control as demand increases. Whilst the number of people having a bad experience may seem large many times more will have a good experience and wonder what the fuss is all about.
A question I asked myself is what is happening behind that front door? Is there any good news out there? What is the NHS good at? I went looking and quickly found ten NHS wins you never heard of. Much of the data quoted in this article comes from OECD Health at a Glance 2023. It is a great way of understanding how our system shapes up against those of other rich countries. Some of the data is really quite eye opening.
- The UK took out 40% of its stroke mortality in a decade and overhauled Germany
The UK is listed 12th in the OECD (developed countries), one place above Germany. In ten years from 2010 to 2020 the UK reduced its stroke mortality by 40%.
It is very clear that stroke treatment in the UK improved massively in the previous decade due to the programme of concentrating stroke care in specialist centres and that the UK climbed the international rankings.
- The UK knocked one third off its heart disease mortality in a decade
The UK is listed 22nd in the OECD, still four places above Germany. The UK reduced its heart attack mortality by 32% in the decade 2010 to 2020 further opening an already noticeable gap with Germany. In 2020 the average German was 22% more likely to die of a heart attack than a Brit.
- England halved TB incidence in a decade
Tuberculosis (TB) is formally a notifiable disease and clinicians have a statutory duty to report it. TB fell to a comparatively low point in 1986 but started creeping up again in the 90s. It peaked from 2005 and kept around the 15 notifications per 100,000 population mark until it finally reached its highest point in 2011, hitting 15.6 notifications per 100,000.
Since the 2011 peak the NHS has embarked on a huge action plan to reduce incidence of TB in England. The latest figures available for TB date back to 2021 and they show a rate of 7.8 notifications per 100,000 population. As well as precisely halving TB in a decade for the first time ever England has fallen below the WHO benchmark for a low incidence TB country, which is 10 per 100,000.
- The suicide rate among mental health service users in England has halved
In its latest annual report the National Confidential Inquiry into Suicide and Safety in Mental Health shows that the NHS in England succeeded in halving the suicide rate among mental health service users from 98.5 per 100,000 service users in 2010 to 47.2 in 2020, a reduction of 52%.
- You are 2.5 more times more likely to die of chronic kidney disease in Germany than you are in the UK
A 2020 paper in the Lancet looking at the national burden of chronic kidney disease listed the UK 4th in Western Europe at 4.5 deaths per 100,000. Finland noses ahead of the UK at 4.0. France does well just behind the UK at 4.9. Essentially most other Western European countries are almost twice as bad as this leading group. Austria (12.4) and Germany (11.3) are very bad. If you live in Germany you have 2.5 times more chance of dying from chronic kidney disease than you do in the UK.
- You are almost twice as likely to die of diabetes in Germany than you are in the UK
Looking at diabetes mortality from the OECD Health Statistics database, the UK is the third best out of the old, rich EU-15 countries, beaten by Belgium and Finland (again). Finland does very well, France is 16% worse than the UK but Germany is 87% worse. You are almost twice as likely to die of diabetes in Germany than you are in the UK. Avoid Portugal, Austria and Italy where the death rate is comfortably more than twice as high.
- Children’s hospital tooth extractions falling – almost 1/3rd lower than under New Labour
You might be forgiven for thinking that children’s tooth decay and the phenomenon of children having their “rotten teeth” extracted in hospital was some kind of awful new problem that had only arisen in recent years. The Mirror thinks so.
It is hard to find comparable data that goes beyond 2012 but I have found a paper in Nature [Moles and Ashley 2009] that covers the first 9 New Labour years and the huge 66% growth in childhood hospital tooth extractions due to decay in that time. The more recent stats are Hospital-based tooth extractions in 0 to 19 year olds from the Office of Health Improvement and Disparities.
Between 2005/6 and 2021/22 the child population increased 12% from 12.9 million to 14.5 million. So, whilst the number of extractions fell 20% between 2005/6 and 2021/22 the rate of extractions fell faster at 29%, almost one third.
- England has seen primary rickets diagnoses halve since 2010
This data from NHS Digital for England gives us some insight into rickets which is caused primarily by vitamin D deficiency, especially in BAME people. These are quite small numbers so it is perhaps unwise to compare annual figures, especially for primary diagnoses. If you take the first three years (2007/8-2009/10) and compare with the last three years (2020/21-2022/23) you get a 43% drop in primary diagnoses and a 17% drop in secondary diagnoses.
If you consider that the number of children in the UK grew from 13.0 million in 2008/9 to 14.5 million in 2021/22 then the relevant population (the vast bulk of active rickets is seen in children) grew by 12% and you can say the rate of primary diagnoses has fallen 48% and secondary diagnoses 19%.
- Smoking down faster, further than New Labour managed
According to ONS, in 1974 almost half of the adult population (46%) smoked in the UK. By 1997 that had gone down to just a bit over a quarter (27%). During the New Labour years the numbers dropped again from 27% to 20%, so a 7% drop in the 13 years.
Since then progress has continued and the progress has been faster in the most recent 12 years for which data is available than it was in the 13 years of New Labour. So, smoking in adults in the UK has gone from from 20% in 2010 to 11% in 2022, that’s another 9% drop.
- Hepatitis C infections halved in last 7 years
Only last week the UK Health Security Agency updated its Hepatitis C in England 2023 report. Until 10 years ago the Hepatitis C virus (HCV) had been a growing cause of death from liver disease, associated very often with intravenous drug use. Unfortunately this is yet another case of morbidity and mortality being allowed to grow under New Labour.
In the seven years from 2015 to 2022, the number of people living with chronic HCV infection in England has dropped by 51.6% and is now estimated at 62,600. So HCV infections have more than halved in just 7 years.