NHS loses crown as world’s best healthcare system

UK slips to fourth place out of 11 overall, and rated only ninth on healthcare outcomes

The NHS has lost its rating as the best healthcare system in the world, an accolade it had held for seven years.

In a survey of healthcare in 11 wealthy countries, the UK has been ranked only in fourth place, dropping down from first in 2017 and 2014.

And it came only ninth in a comparison of healthcare outcomes, which includes early deaths, cancer survival and baby deaths at birth.

The study, by American think tank the Commonwealth Fund, found Norway, the Netherlands and Australia were the top-performing countries overall, ahead of the UK.

Issues such as access to care and the experiences of lower-income groups were blamed for the NHS’s slipping.

Following exceptional demand for care during the pandemic, the number of people in England waiting to start routine hospital treatment rose this summer to a new record high, of 5.1 million people.

Last month the care watchdog warned that “exceptional” pressures on the NHS was affecting the care of patients across England with healthcare workers pushed to the brink.

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“The UK’s drop in rank from #1 to #4 is associated with that country’s lower performance on several domains (such as access to care and equity) compared to 2017,” the report says.

However, the UK came top for affordability.

The study scored the 11 countries on access to care, care process, administrative efficiency, equity and health care outcomes.

“Access to care includes measures of healthcare’s affordability and timeliness. The Netherlands performs best on this performance domain among the 11 countries, ranking at or near the top in both subdomains. Norway and Germany also performed well on access to care, but all three are outranked on affordability by the UK,” the report says.

It scored the US last overall, despite its spending far more of its gross domestic product on healthcare than Norway, the Netherlands and Australia.

The US also came bottom on all measures except care process, which covers preventive care, safe care, coordinated care and patient preferences. Here, the US was ranked second.

The NHS, long considered the envy of the world, was fourth for access to care, administrative efficiency and equity, and was fifth for care process.

Siva Anandaciva, chief analyst at the King’s Fund, a UK health think tank, told The Guardian: “According to this report, our previously world-beating health service is at risk of moving to the middle of the pack, largely due to growing delays across the system in people’s ability to access care quickly.

“We can’t brush this under the carpet as being solely a consequence of the impact of the pandemic on patients, staff and services.

“Even before Covid, waiting lists for treatment were already sizable after a decade of stalling funding and a growing workforce crisis.”

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The report said four features distinguish top-performing countries from the US:

• They provide for universal coverage and remove cost barriers
• They invest in primary care systems to ensure that high-value services are equitably available in all communities to all people
• They reduce administrative burdens that divert time, efforts and spending away from health improvement
• They invest in social services, especially for children and working-age adults.

This article was amended shortly after publication on 5 August 2021. An early version said the UK came top for affordability and timeliness, but it did not come top for timeliness.