Ashish K. Jha+ Your Authors @ashishkjha Physician, health policy researcher, and advocate for the notion that an ounce of data is worth a thousand pounds of opinion. Also Director of @harvardgh Nov. 29, 2019 2 min read + Your Authors


1/9 Our @bmj_latest paper on the state of the UK National Health Service is out. We examined @NHSuk performance compared to other countries on 79 metrics.

What did we find? 

2/9 The UK NHS spends less on healthcare than any comparator country – and has been growing more slowly –

And the fiscal austerity is starting to show.

But first, the good news from our data on the NHS.

3/9 Everyone’s covered (we knew this)

People perceive reasonably good access --- very few felt unmet needs due to costs.

That’s a good thing!

But access times are starting to get a bit stretched – longer wait times for specialists

4/9: Primary care system seems to be strong, with good patient experience of care coordination, low rates of avoidable hospitalizations

5/9: So where are the challenges?

1. Under funding means fewer doctors, FAR fewer nurses than comparator countries

2. Not surprisingly, doctors have less time to spend wit patients

3. Nursing inflow to UK got MUCH worse after Brexit vote. See graph:


Low spending

Low staffing levels

But population level utilization about average

What does that mean?

The amazing front-lines of the NHS are doing more with less.


And while UK doing reasonably well on many different outcome metrics (e.g. patient safety),

the UK faces challenges in other areas including acute mortality from heart attacks, strokes, as well as cancer outcomes


One area of particularly concern is maternal mortality, where UK is high and heading in the wrong direction.

9/10 What does this all mean? My take:

1. @NHSuk is a very good system that works well for the British people
2. It has been clearly underfunded in recent years
3. It is now a system stretched – with strains that are starting to show


4. Front lines doctors, nurses, NHS leaders doing heroic work – more with less – but it can’t go on

5. Brexit will add substantially to strains on the system

6. Lots of ways to make progress (more £, focused on specific areas) but more of status quo won’t work


And none of this work would be possible without amazing leadership from @IPapanicolas, awesome collaborators @lwoskie @MOSSIALOS at @LSEHealthPolicy and our friends at @OECD

You can follow @ashishkjha.


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