Phil Taylor

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. 

Only this 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. 

The UK is working to eliminate HCV by reducing chronic prevalence, rolling out testing and lowering of mortality associated with HCV infection. 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. 

This is largely due to improved testing and access to treatment with comparatively new drugs called direct-acting antivirals (DAAs). This improved testing and treatment has reduced HCV-related mortality to 0.44 per 100,000 population. This is the lowest mortality rate for 10 years.

This is my 10th and final, for now, NHS wins you never heard of. 

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.

Even without a headline piece of legislation such as the Health Act 2006 which brought in the smoking in the ban on smoking in enclosed public places ban on 1st July 2007, the NHS has done better in recent years than it did under New Labour, quietly persuading people in surgeries and clinics. 

Note England keeping its nose ahead of the devolved administrations. 

Charts from House of Commons Library. Percentages from ONS (same data used in charts).

Another “Victorian disease” which the left is quick to talk up is rickets. Ironically, again, the incidence of rickets grew under New Labour and has fallen since. 

The charts above take data from NHS Digital for England. Primary diagnoses mean people who are admitted because of rickets. Secondary diagnoses mean people who are admitted with rickets but something else caused the admission. 

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%. 

With rickets levels peaking in early 2012 the chief medical officers of the UK wrote to clinicians to stress the need for Vitamin D supplementation. 

When looking at rickets in under 16s this study [Julies, et al 2020] in the BMJ Archives of Disease in Childhood found that: “The incidence of nutritional rickets in the UK is lower than expected” at 1 per 200,000 children. 81% of the children with rickets were BAME and 78% were not taking Vitamin D supplementation in spite of being eligible for a free supply. 

Rickets is not some generalised Victorian poverty plague. It is largely a specific problem of children with darker skins not getting the Vitamin D they need to thrive in a Northern climate. Talking in a generalised way about poverty and austerity will not get information to BAME mothers that keeps their children healthy. 

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 much of the New Labour years and the huge 66% growth in childhood hospital tooth extractions due to decay in that time. 

It is worth remembering when this problem got out of hand. From 2000 it was decided, rightly I am sure, that because pretty much all childhood tooth extractions were done under general anesthetic and because general anesthetic carries inherent risk then all such procedures should be carried out in hospital. Some of this 66% rise in 8 years can be attributed to this move from primary care to secondary care. But, the number just kept going up after what should have been a pretty sharp regulatory cut off. The chart tells a story of continuing deterioration. The child population increased fractionally in this period from 12.7 to 12.9 million, some 1.6%. In the 9 years 412,358 childrens’ teeth were extracted in hospital. The Moles and Ashley work considered only those under 18. 

The more recent stats are Hospital-based tooth extractions in 0 to 19 year olds from the Office of Health Improvement and Disparities. I am a bit confused as to when and why 18 years olds have been defined as children. 

Extractions due to tooth decay fell 15% in the five years before Covid hit and then collapsed for obvious reasons. It is not clear that the 2021/22 figures have fully rebounded yet or whether next year’s figures will show further rebound. 

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. Bear in mind that, unaccountably, the modern numbers now include adult 18 year olds. Once more the data confounds the narrative. 

Another area where the NHS does well compared to Europe is in diabetes care. I made this chart from the OECD Health Statistics database. It looks at diabetes mortality for the year 2020 or the most recent year for which data is available. If you take the 15 countries in the old, rich EU-15 and look at their diabetes mortality you will find that the UK is the third best, 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. 

Using the OECD Health Statistics database, I charted the UK and German data from 2010 to 2020 below. It shows diabetes mortality increasing 23% over 10 years in the UK. Whilst this doesn’t sound like great news it needs to be borne in mind that diabetes prevalence increased much, much faster in this period. For instance, one estimate of prevalence for England I found showed diabetes increasing 44% in the 9 years from 2008/9 to 2017/18. Not quite the same time period but makes the case that prevalence is way up. This piece talks about diabetes doubling in 15 years. So already good diabetes care in the UK got better faster than the rate of the disease increase in the population leaving the UK third on this metric. It is an example of one of the areas where all developed world health systems have to run really hard just to stand still. 

This isn’t the best image. It is taken from a paper in the Lancet: Global, regional, and national burden of chronic kidney disease (CKD), 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. It shows the age standardised mortality rates for chronic kidney disease in Western European countries. The UK (4.5) isn’t the best, it is the 2nd best to Finland (4.0). I am not going to count Iceland (4.3), which is the same size as the borough I live in nor Andorra (3.6) which is a quarter of that!

The UK comes in at 4.5 deaths per 100,000 in 2017. 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. The UK has always done well at renal medicine. For some reason it suits our system and inclinations. If you live in Germany you have 2.5 times more chance of dying from chronic kidney disease than you do in the UK. 

The NHS and the wider state has been becoming less accepting of the inevitability of suicide since the 90s. Current suicide statistics run back to 1981. The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness was established in 1992. A milestone was the World Health Organisation’s “Prevention of suicide: Guidelines for the formulation and implementation of national strategies” 1996. This work carried on under New Labour and with the Coalition and subsequent governments, for instance the 2012 Suicide prevention strategy for England specifically identified “people in the care of mental health services, including inpatients” as a priority. 

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%. 

Under the Conservatives:

– 350,000 children are on NHS waiting lists
– 12,000 of them waiting more than a year
– Almost 500 for two years!

Rising child poverty has seen the return of Victorian diseases and massive health inequalities.

Read more 👇🏻https://t.co/uY944K9ZG5

— Wes Streeting MP (@wesstreeting) June 20, 2022

This blog will be slightly more partisan than the rest because some of the more disreputable voices in the Labour party, and I would include Labour health spokesman Wes Streeting in this, have talked casually and very misleadingly about Victorian diseases in recent years. One particular Victorian disease that New Labour bequeathed to the Coalition and subsequent governments was elevated levels of tuberculosis, TB. 

This chart is taken from the NHS Tuberculosis in England, 2022 report which includes data up to 2021. It shows the rate of TB notifications. 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. 

I am not quite sure why it was allowed to creep up but if you read the report you will find that most TB is imported, particularly from the Indian subcontinent. I can’t help thinking that the same squeamishness that caused grooming gangs to be ignored in Northern cities kept TB on the back burner. 

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.

So, my third NHS win is halving the incidence of TB in 10 years. 

The heart disease chart from OECD Health at a Glance 2023 is not quite as impressive as the stroke one but still it tells a story of massive improvement in the previous decade. Heart attack and other ischaemic heart disease down by one third. The UK is listed 22nd in the rich world (the OECD countries), still four places above Germany. Some surprising countries beat us but unfortunately people in countries such as Chile, Costa Rica, Argentina and South Africa probably die of other things before they die of heart attack. No European country is going to emulate Korea and Japan and their diets very quickly to match them in this area. 

Ten years ago the UK was 19th with Germany one place behind. Source: OECD Health at a Glance 2013. 

Again, the data from 2010 to 2020 is available from the OECD Health Statistics database. I charted the UK and German data below. It shows the UK reducing 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. 

Again, it is very clear that heart attack treatment in the UK improved massively in the previous decade. We should not be complacent however. France and the Netherlands are miles ahead. We should be looking at what they do and work out how to get up to where they are.