The NHS leads the world at ensuring equal access to treatment but underperforms compared with other developed countries’ healthcare systems in preventing common causes of death, a major analysis has found.

The report, which will fuel further debate about the current state of the NHS, also found that the UK has fewer doctors, nurses, hospital beds and CT and MRI scanners than 18 other comparable countries.

The research was carried out by the Nuffield Trust, the Health Foundation, the Institute for Fiscal Studies (IFS) and the King’s Fund. It determined that, with the NHS free at the point of use, the UK had the lowest proportion of people who avoided healthcare due to cost. Just 2.3% did so in 2016 compared with an average of 7.2% across the 19 countries, including France, Germany, Italy, Japan and the US.

However, the UK’s health service performed worse than average in the treatment of eight out of the 12 most common causes of death. They included deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer.



The NHS was also the third-poorest performer in cases where medical intervention should have prevented death, and had consistently higher death rates for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality).

Nigel Edwards, chief executive of the Nuffield Trust, said: “Discussion about the NHS is often marked by an unhelpful degree of exaggeration, from those that claim it is the envy of the world to those who say it is inferior to other systems.



“The reality is a much more mixed picture, but one thing is clear: we run a health system with very scarce resources in terms of staff and equipment and achieve poor outcomes in some vital areas like cancer survival.”

The NHS had a lower than average number of staff for all professional groups except midwives, with one doctor for every 356 people in the UK, compared to one for every 277 people on average.

The UK had fewer beds per person than 16 of the 18 other countries and the lowest levels of both CT and MRI scanners, while it spends a slightly below average proportion of national income on healthcare, the researchers found.

The UK fared better when it came to efficiency, having the largest share of generic prescribing of all comparator countries (84% in 2015 compared with an average of 50%). It also performed well in managing patients with some long-term conditions such as diabetes and kidney diseases.

While record numbers of people waiting at A&E and for treatment have caused alarm in the UK, the researchers found that the NHS was in the middle of the pack on both these measures internationally.

Defending a charges of neglect of the NHS, the government has often trumpeted the Commonwealth Fund health thinktank’s judgement of the NHS as the best, safest and most affordable healthcare system out of 11 rich countries. But other analyses have not been so flattering, including the the 2015 Euro Health Consumer Index, which ranked the NHS 14th in the continent.

The thinktanks behind the latest analysis, published on Monday, said both the NHS’s most ardent supporters and most vociferous critics were misguided. The Health Foundation’s chief executive, Dr Jennifer Dixon, said: “We can be proud of the fact that the UK is a standout nation where people are not put off from seeking care due to cost, and the NHS is cheap to run. But austerity has bitten hard, and the lack of investment shows.”

Chris Ham, chief executive of the King’s Fund, described the report as “a timely reality check”, while the IFS director, Paul Johnson, said the NHS was “a perfectly ordinary healthcare system”.

The thinktanks joined together for the first time for the report, published by the BBC, which also compared Australia, Austria, Belgium, Canada, Denmark, Finland, Greece, Ireland, Netherlands, New Zealand, Portugal, Spain, and Sweden.

A Department for health and social care spokesman referenced the Commonwealth Fund report and said: “We are taking strong action to help people live longer and healthier lives—cancer survival is at a record high while smoking rates are at an all-time low.”

An NHS England spokesman said: “Although the NHS has been under great pressure, this report shows once again that our health service provides outstanding care for many conditions in a way that is both fair and efficient. But the report also rightly highlights areas for further improvements, which need to be addressed head on in the NHS’s long term plan for the decade ahead.”