There is always a lot of interest in how the NHS compares internationally.
A recent story in The Times cited the Organisation for Economic Co-operation and Development (OECD) data showing that the UK has the second lowest number of hospital beds per person in Europe.
This was presented as a problem, with references to ‘overcrowding’. But is the real picture rather different?
The first question is whether we’re comparing like with like. You might think that counting beds is easy. After all a bed is a bed, isn’t it?
Actually, it’s not quite that simple. In order to be counted by the OECD, a bed must be regularly maintained and staffed and immediately available. The OECD doesn’t count beds for same-day care. So doing more day surgery reduces the need for beds. Yet some countries’ own data include beds used for day cases – thus overstating their numbers. Moreover, while the data for some countries includes hospital beds in the private sector, these are not included in the UK data.
Secondly, even if we could be confident in the data, are fewer beds necessarily a bad thing? Just looking at the number of beds is not enough. We need to also to look at information on length of stay and admissions. Advances in medicine mean that more and more patients can be treated and discharged on the same day. The risk of hospital acquired infections is another reason to keep lengths of stay to a minimum. If lengths of stay are shorter, fewer hospital beds are needed in order to treat the same number of people. The fact that people with chronic diseases, mental illness, frailty and dementia have better outcomes if they can be supported to stay independent for as long as possible means most countries are trying to treat more patients at home or as close to home as possible and actively seeking to reduce unplanned admissions. Success with this would reduce the amount of hospital beds per head that are needed.
So finally, given the above, how might we interpret the OECD data? Firstly, in England, day cases now account for nearly 80% of all inpatient episodes. Comparative data suggests our rates for day case cataract surgery are among the highest at nearly 98% (OECD health data 2011). Secondly, according to the European Centre for Disease Prevention and Control, England had one of the lowest incidences of healthcare acquired infections in acute hospitals in 2011-12, at just 2.2%. Thirdly, while some other countries still have large long-stay hospitals for people with mental health problems and older people, England has very few such facilities. The NHS also has a strong tradition of primary care and is committed to providing proactive support particularly to frail older people and those with long term conditions in the community. All of which suggests that a lower number of acute hospital beds per head might not be such a bad thing after all.
The challenges of making comparisons were confronted by the authors of the recent Nuffield Trust/ Health Foundation report report on how the NHS varies across the United Kingdom. Even within the UK, data is not always collected and reported using the same definitions. The authors called for a 'more comparable and wider range of comparative performance data'. They rightly argued that this would help us better to evaluate the impact of different policies in different parts of the UK. While much has been made of comparisons of waiting times, it is important to consider what data would be most valuable. A good start would be if clinical audits across all four home nations collected the same information about the quality of care and we used the same questions when asking patients about their experiences of care.
If we are to learn from other countries internationally and from best practice at home, more comprehensive comparable data would help, but careful interpretation is essential before judgements are reached.
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1 comment
Comment by Paul Shannon posted on
I presume you know about the Euro Health Index,
http://www.healthpowerhouse.com/index.php?Itemid=55,
which provides 'apples and apples' comparisons of European Health Services? UK is 14th (as usual); the Top Ten are all insurance-based. Do the maths!