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How Britain’s Healthcare System Stopped Being the Best in the World

In the first of a series investigating the state of healthcare in Britain, Sian Norris explores how it fell from its top spot compared to other leading economies on key health indicators

A busy corridor in an NHS hospital. Photo: Lankowsky/Alamy

How Britain’s Healthcare SystemStopped Being the Best in the World

In the first of a series investigating the state of healthcare in Britain, Sian Norris explores how it fell from its top spot compared to other leading economies on key health indicators

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It’s been a chaotic time for the Department for Health and Social Care after the Secretary of State Sajid Javid resigned over his lack of trust in Prime Minister Boris Johnson. Whatever happens next in British politics as the Conservative Party chooses yet another leader and Cabinet one thing is certain: the next Health and Social Care Secretary faces a National Health Crisis.

According to the Commonwealth Fund’s Mirror, Mirror 2021 report, which measures the efficacy of health services in leading economies, the UK has dropped from being number one in the world to ranking fourth behind Norway, the Netherlands and Australia. When it came to healthcare outcomes the UK ranked 9th – with only Canada and the US performing worse. 

It was as recently as 2017 that the UK held the top spot – although it still ranked poorly on healthcare outcomes. In 2014 the UK was ranked number one overall, as well as for quality of care, access to care, and efficiency. 

The period of decline has seen NHS funding cut in real terms – although there was a funding boost during the first two years of the pandemic. Healthcare spending as a percentage of GDP is no guarantee of good outcomes: the Mirror, Mirror 2021 report found the US spent the most while failing the hardest. But there is no doubt that the UK’s drop in ranking correlated with a drop in spending. Spending on healthcare as a percentage of GDP was 10.2% – putting the UK behind the US, Switzerland, Germany, France, Sweden, Canada and Norway. 

The annual increases to Government spending on health fell to less than 1% under 2010’s Coalition Government, before creeping up to just under 2% before 2019 – compared to 6% annual increases under Labour. At the same time, private sector involvement in the health service has gone up.

A Demoralised NHS Workforce in Crisis

Sian Norris

Health Outcomes 

The Coronavirus pandemic has exacerbated pressures on the NHS – from the backlog of postponed treatments, to people suffering the effects of Long COVID, to the fact that people avoided seeking medical care in order to protect the NHS during the hardest days of the crisis.

But data analysed by the Byline Times suggest that even before COVID-19 hit the UK in early-2020, the country was already behind some of its European peers on health outcomes. 

One of the key indicators of a country’s health is life expectancy from birth. 2019 data from the World Health Organisation (WHO) placed the UK 17th out of 39 European countries, at 81.4 years for both sexes. This puts the UK behind similar-sized economies such as Austria, Germany, France, Spain, and Italy – as well as the Scandinavian countries Norway, Sweden and Finland, and smaller economies such as Cyprus, Malta, and Ireland. 

The country with the highest life expectancy from birth is Switzerland, at 83.45 years. Close to the UK was Belgium at 81.42 years and Denmark at 81.32 years. 

The nations ranked below the UK tended to be in Eastern Europe, including former members of the USSR, with Ukraine ranked lowest at 73.02 years. This figure is from 2019, before Russia’s invasion of the country. Moldova has a life expectancy of 73.26 years’ Georgia at 73.28; and Macedonia is 74.82 years. 

COVID-19 caused a decline in decreasing life expectancy in the UK. Overall life expectancy in England and Wales fell by 0.93 years during the height of the Coronavirus pandemic – the second biggest decrease in the world’s leading economies after the US.

Further, there have been statistically significant increases in inequality of life expectancy, with men and women living in the most deprived areas of England living shorter lives in 2018-2020 when compared to data from 2015 to 2017. 

Men in the most deprived areas of England and Wales now have a life expectancy of 73.5 years compared to 83.2 years for men in the least deprived areas. Women living in poverty can expect to live for 78.3 years, while wealthy women have a life expectancy of 86.3 years. 


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Life expectancy is one marker, a second is the causes of death. WHO data on the probability of dying from non-communicable diseases – cancer, cardiovascular disease, diabetes or respiratory disease – puts the UK 11th in its list of 39 European countries, with people having a 10.3% chance of dying from one of these conditions between ages of 30 and 70. 

This puts us marginally ahead of some of our peer economies – in France the percentage is 10.58 and in Germany, it is 12.05%. However, the UK lags behind the Scandinavian countries – in Sweden, it’s 8.38%; Norway is 8.69%; Finland is 9.6% and Iceland is 8.65%. As with life expectancy, the most at-risk populations are the smaller economies in Eastern Europe. 

The age-standardised rate of mortality from cancer has decreased for both men and women in England. For males, the rate decreased from 313 deaths per 100,000 in 2018 to 307 deaths per 100,000 in 2019. The EU average for men was 335.9 per 100,000 and Bulgaria, Cyprus, Luxembourg, Malta, Austria and Switzerland had lower death rates. 

Cancer death rates for women in the UK were 216 deaths per 100,000 people in 2019. The EU average was 193.3 per 100,000, with Belgium, Bulgaria, Germany, Estonia, Greece, Spain, France, Italy, Cyprus, Lithuania, Luxembourg, Malta, Austria, Portugal, Romania and Switzerland all having better survival rates for women with cancer.

Maternal mortality is relatively low in Western Europe, with figures from 2017 ranking the UK sixth in the region at seven deaths in 100,000 live births. The UK sits with Germany, Macedonia, and Slovenia. France is ranked below the UK, with 8 deaths for every 100,000 live births. 

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