Scotland’s death rate greater than rest of UK

Scotland has higher death rates than the other UK countries. Picture: Gordon Fraser

The report, focussing on health performance in the devolved nations, found that all countries more than halved amenable mortality - deaths which could be prevented through better health care - between 1990 and 2010.

But the Nuffield Trust and Health Foundation found that amenable deaths remained about 20 per cent higher in Scotland than in England in the latest figures.

The report, which focussed on more than 20 measures of health including waiting times and spending, found significant improvements across the UK, linking particular progress in Scotland to tougher performance management and targets.

But it also highlighted the different policies on health and healthcare spending which exist in the four nations, with greater emphasis on patient choice and private sector use in England and the rejection of competition to provide NHS services in Scotland and elsewhere.

On the issue of mortality, the report - The Four Health Systems of the UK: How do they compare? - found large declines in the last two decades in all the nations.

But despite these drops, mortality rates remained higher in Scotland than elsewhere.

On amenable mortality rates, the report said: “By 2010, the gaps between countries had narrowed in absolute but not relative terms: for example, amenable deaths remained about 20 per cent higher in Scotland than in England.”

In 1990, rates of amenable mortality per 100,000 people under 75 were highest in Scotland at 234 for men and 172 for women and lowest in England, at 186 for men and 140 for women.

By 2010 the rate had dropped but the gap remained, with a rate of 98 for men and 78 for women in Scotland compared to 81 for men and 65 for women in England.

A similar gap was also seen in mortality rates for other deaths - those not amenable to healthcare - according to the report.

The researchers also compared performance with the North East region of England, and found Scotland’s death rates were also higher than their close neighbours.

In the 1990s, overall mortality rates were similar in Scotland and North East England. But by 2010 the report said these rates were 15 to 19 per cent higher in Scotland compared to the North East.

The report added: “The [North East] region had similar life expectancy to Scotland in 1991, but by 2011 men and women lived a year longer than their Scottish neighbours.”

Dr Jennifer Dixon, chief executive of the Health Foundation, mortality rates could be affected by factors outside the NHS, including public health measures and wider economic issues.

“It is a very difficult area to influence. What’s pleasing is that it is improving across all four nations, but the differences between England, Scotland, Wales and Northern Ireland look as if they are pretty intractable at the moment because the gap [in mortality] is the same,” she said.

Dr Dixon said the comparison between Scotland and North East England was interesting because it showed faster improvements in mortality in the North East.

“The acceleration in the North East is true not just for amenable mortality but also other types of mortality. It suggests that the improvements being made are less to do with the health sector than they are to do with wider determinants,” she added.

Dr Dixon said those working in public health in Scotland may find it useful to see what was happening in the North East of England to see if there was anything that could be done differently.

The report also highlighted the “divergent spending decisions” made by the different parts of the UK.

It said that the governments of the devolved countries did not increase their health spending proportionately as much as England from 2000/01 to 2011/12.

The report said if they had, they estimated that the extra amount they would have spent on health care would have been £900 million in Scotland and over £400 million in Wales and in Northern Ireland.

It said, instead, Scotland could afford to fund the costs of free personal and nursing care for people aged 65 and over from this extra amount.

Andy McKeon, from the Nuffield Trust, said: “Our study coincided with the biggest sustained injection of cash the four health systems have ever seen, so it’s perhaps unsurprising that staff numbers have increased and performance has improved.

“But what is interesting is that, despite hotly contested policy differences in structure, targets, competition, patient choice and the use of non-NHS providers, no one country is emerging as a consistent front-runner on health system performance.”

Health Secretary Alex Neil said: “I welcome this study which shows that we have made significant improvements in our health service in Scotland.

“In particular, the report highlights that we are leading the way in the UK on reducing waiting times for treatment, in recognition of the fact that waiting times remain among their lowest ever levels in Scotland.”