Intended for healthcare professionals

Analysis NHS at 70

Healthcare outcomes and quality in the NHS: how do we compare and how might the NHS improve?

BMJ 2018; 362 doi: (Published 13 July 2018) Cite this as: BMJ 2018;362:k3036
  1. Azeem Majeed, professor of primary care1,
  2. Dominique Allwood, assistant director of improvement2,
  3. Kim Foley, patient1,
  4. Andrew Bindman, professor of medicine, health policy, and epidemiology and biostatistics3
  1. 1Department of Primary Care and Public Health, Imperial College London, London, UK
  2. 2Health Foundation, London, UK
  3. 3UCSF School of Medicine, San Francisco, CA 94118, USA
  1. Correspondence to: A Majeed a.majeed{at}

Azeem Majeed and colleagues examine what the NHS needs to focus on to achieve better health outcomes

Health outcomes in the United Kingdom have improved substantially since the NHS was established in 1948.1 For example, average life expectancy has increased by around 12 years from 68 to 80 years; and infant mortality has fallen nearly 90%, from 34/1000 live births to less than 4/1000.2 The NHS performs well in many international comparisons on measures such as efficiency, equity, and access.3 Despite these achievements, however, problems with health outcomes remain.34 Moreover, other European countries have also improved their health outcomes in recent decades, often at a faster rate than the UK. Consequently, the UK now lags behind many other European countries in key health outcomes in areas such as child health and cancer survival. Here, we review the quality of care and health outcomes in the NHS, focusing on areas that are important to patients, policy makers, and clinicians4 and for which there are comparative international data.

How does the NHS compare with other countries?

Life expectancy

One important measure of population health, which is less prone to bias than some other measures, is the average life expectancy in a country. For men, current average life expectancy in the UK (79.2 years) is around the average for countries in the Organisation for Economic Cooperation and Development (OECD). For women, the average life expectancy—although higher than for men—is below the average for the OECD (82.8 for the UK versus 83.9 for the OECD).4

Child health

Improvements in child mortality in the UK have lagged behind those seen in many other European countries. For example, the average infant mortality in the 28 current members of the European Union (EU28) in 1961 was 36.2 per 1000 births, substantially above the level in the UK in that year (22.1); but …

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