A NEW report published last Thursday, 22 August, by the Health Foundation found that the UK’s performance on hospital-based care is consistently languishing near the bottom in a public survey of 10 high income countries.
The analysis of the 2023 Commonwealth Fund survey highlights key areas where the UK performs poorly, particularly on long waits for specialist care, lack of access to out-of-hours care and affordability for treatments like dental care.
Over 21,000 people from across 10 developed countries took part in the survey last year, including over 3,000 from the UK.
The countries that took part in the survey were: Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the US and the UK.
A total of 21,341 participants took part in the survey, including 3,361 living in the UK. Respondents for the 2023 survey were selected, using a random sampling approach, to be representative of adults in each country
Participants were asked a series of questions related to their experience of healthcare, including access to hospital care and general practice, affordability and care coordination.
For hospital care, the UK had among the longest waiting times compared to the other countries in the survey, with 11% of people waiting a year or more for a specialist appointment and 19% waiting a year or more for non-emergency surgery. Only Canada is comparable.
The report also highlights that waiting times for a specialist appointment have risen more rapidly in the UK than in other countries. In 2023, 61% of people in the UK reported waiting more than four weeks for a specialist appointment, up from 14% in 2013.
On general practice, the UK is one of the better performing countries for people reporting same or next day appointments (42%), however the report highlights a number of areas where the UK performs less well.
Only 16% of people in the UK reported it was ‘very’ or ‘somewhat easy’ to get medical care in the evenings and weekends without going to A&E.
And the UK performed towards the bottom on people’s experience of seeing a GP, including having things explained in a way they could understand and spending enough time with their GP.
The UK also performed poorly on care coordination between health care professionals (eg GPs and specialists).
The survey shows that problems related to the affordability of healthcare have grown significantly in the UK since 2013. In 2023, 26% of people skipped dental care or dental checkups because of the cost, compared to just 6% of people in 2013.
While the NHS remains mostly free at the point of use, the proportion of people who did not visit or consult with a doctor for cost reasons tripled in the last 10 years, from 2% of people surveyed in 2013 to 7% in 2023, which is likely due to recent increases in living costs.
The Health Foundation’s Assistant Director of Policy Ruth Thorlby said: ‘These findings show the UK consistently coming near the bottom of the pack on people’s experience of healthcare compared to other high-income countries. It sheds yet more light on just how much work the government has to do to get the NHS back on its feet.
‘The UK is not alone in the challenges it faces but the combined effect of the pandemic and below average spending growth has left the NHS in a fragile state.
‘The government is right to prioritise bringing down waiting lists, but that can only be done with a concerted effort to improve primary care and ensuring good coordination between hospitals and GPs.
‘National and local health leaders also need to be vigilant against creeping costs denying people access to healthcare. Nowhere is this more apparent than dental care where too many people are avoiding treatment due to costs.
‘If these trends continue, the risk is that more and more people, particularly from deprived communities, will delay seeking care, which could store up more health problems in the future.
‘There are no quick fixes, but the NHS can recover with the right mix of policy change, innovation and investment.’
Responding to this Commonwealth Fund 2023 International Health Policy Survey, comparing patient experiences of health systems in 10 high-income countries, British Medical Association (BMA) council chair Professor Phillip Banfield said:
‘We know waits for hospital care are at near-record levels in the UK, but the dire situation is underlined when we see ourselves alongside other countries we should be performing well against.
‘As the Health Foundation itself points out, while all nations have struggled with recovering after the pandemic, below-average spending on health in the UK has made pressures here even worse, and we mustn’t forget that waiting lists were already at record highs before Covid arrived.
‘It’s not all negative, with patients in the UK able to get quick appointments at their GP practice – a testament to the dedication of family doctors and their teams against the odds, and in stark contrast to some of the negative narrative promoted in the media.
‘But we still have a huge workforce crisis, which is not only a driver of long hospital waits, but also means patients are struggling to get care out of hours.
‘This study therefore raises the question of how the government plans to deliver more appointments at evenings and weekends to cut waiting lists, when there are not enough staff to provide round-the-clock care as it is.
‘Continued progress on reversing cuts in the value of doctors’ pay, removing absurd pension rules and improving working and training conditions, all remain absolutely pivotal in recruiting and keeping doctors, much-needed to bring down waiting lists.
‘Meanwhile, poor IT and bureaucracy means that patients’ experience navigating between different parts of the NHS can be incredibly difficult and confusing, while causing frustration for doctors as valuable time is taken away from providing care.
‘Undertaken under the last government, this study reveals the uphill climb the new government has to reverse years of demise in UK healthcare and to restore the NHS’s standing on the global stage.’
Responding to findings around primary care, Dr Andrew Buist and Dr Alan Stout, co-chairs of the BMA’s UK GP committee, said: ‘This report confirms what many patients’ experience of general practice is across the UK – and why we need urgent government intervention to help us rebuild our profession.
‘While it’s promising to see that the UK performs well for patients getting access to same or next-day appointments, it’s clear that the level of care being given is not what doctors or their patients want.
‘That the UK is ranked as one of the lowest countries for the amount of time GPs spent with patients, for example, is a symptom of decades of underfunding and what happens when GPs are expected to do more with less.
‘It’s unacceptable, and things have to change.
‘The government should be under no illusion that results like this will only get worse if general practice isn’t given the resource it needs. Only then can GPs and their teams give the level of care our patients need and deserve.’
