5.3 Key trends and observations
We set out below four notable findings based on analysis of the most recent trends using the selected set of 23 indicators in our updated data dashboard. This is not an exhaustive analysis and does not cover all countries. For comparability purposes, insights are largely drawn from the pool of OECD countries that have reported data for each of the four areas explored.
These metrics are a subset of the full list of 108 metric included in the dashboard, which can be explored for all countries that report data (not just those in the OECD). We encourage users to interrogate the dashboard for insights relevant to their own context and areas of interest.
5.3.1 Mental health
Some aspects of mental health care have improved in recent years. However, excess mortality for people with severe mental illness remains a major concern and source of inequity.
This year, we have included two patient-reported indicators that provide further insight into aspects of mental health care – being involved in decisions about people’s care and treatment and being treated with courtesy and respect. These are factors that can help people feel emotionally safe, and that they have a sense of control over important care and treatment decisions.
The countries in the report show an overall improvement in these two indicators since data collection started in 2017. However, data coverage for these indicators is extremely poor, making it difficult to draw definitive conclusions. The continued adoption and reporting of these indicators should be encouraged. Clearer, and more worrying, is the worsening trend in excess mortality for patients diagnosed with two severe mental illnesses – bipolar disorder (Figure 12) and schizophrenia (Figure 13).
On average, across reporting OECD countries, excess mortality for bipolar disorder rose from 2.7 in 2000 to 3.17 in 2024, representing an increase of 17 per cent. Alarmingly, the rate has been steeper in recent years, with a 21 per cent rise since 2015 alone.
Of the 14 countries with available data, only five – Denmark, Finland, Lithuania, Norway and Sweden – report a decrease between the first and most recent year of data. In contrast, several countries experienced notable rises. These patterns, taken across the past 25 years, suggest that the increase in excess mortality for bipolar disorder reflects a long-term structural issue.
The situation is worryingly similar for patients with schizophrenia. The OECD average increased from 3.0 in 2000 to 5.1 in 2024, representing an overall increase of around 70 per cent, and a 41 per cent rise since 2015.
Research has consistently shown that people with severe mental illness die around 10-20 years earlier than the general population. Moreover, the data suggests that people with severe mental illness benefit less than the general population from broader improvements in healthcare.
Studies have shown that this reduced life expectancy is not only explained by causes such as suicide, but also by physical illnesses including cardiovascular, respiratory and metabolic diseases. One of our interviewees considered this to be the most pressing patient safety concern in their country (see Norway case study).
A recent investigation (2025) in England into mental health inpatient care found several gaps in the provision of physical health care for people with severe mental illness. It recommended improving the consistency of physical health checks, boosting emergency responses, and addressing the common mis-attribution of physical symptoms to mental illness.
5.3.2 Maternal and neonatal health
Average rates of maternal and neonatal deaths continue to fall worldwide. However, the rates and causes of neonatal mortality in the UK, particularly related to preterm births, warrant further investigation and action.
In our 2023 report, we found that overall rates of maternal deaths (deaths of women related to their pregnancy) had fallen by nearly 42 per cent in OECD countries, representing a major global achievement. The latest OECD data we analysed shows that, overall, this trend has continued (Figure 14).
Norway, Australia, Ireland and Iceland have maternal mortality rates significantly lower than the OECD average. Countries such as Denmark, the Netherlands, and Ireland show statistically significant decreasing rates over the past 25 years.
The UK experienced a significant rise in maternal mortality between 2020 and 2022. This was notably higher than most OECD countries. By 2023, maternal mortality rates in the UK fell to just below the OECD mean. However, this improvement relative to the OECD mean should be interpreted with caution.
As can be seen in in Figure 14, the OECD average is skewed upward by a small number of outlier countries (Colombia and Mexico) which report maternal mortality rates more than two standard deviations above the OECD mean. These outliers inflate the OECD average and therefore make countries such as the UK appear closer to the mean. When performance is assessed on a standardised scale, the UK ranks 21st of 38 OECD countries.
The WHO reports that neonatal mortality rates (deaths of babies under 28 days old) have fallen steadily globally from around 30 per 1,000 live births in 2000 to around 17 per 1,000 in 2023. This reflects continued progress in newborn survival worldwide. The OECD average rate of neonatal mortality has fallen steadily since 2000, even accounting for the COVID-19 pandemic (Figure 15), representing a 46 per cent reduction.
Our dashboard highlights some remarkable reductions in neonatal mortality rates in many non-OECD countries between 2000 and 2023. For example, rates fell from 21.4 to 2.8 in China, from 5.2 to 0.8 in Belarus, and from 23.3 to 4.2 in Kazakhstan. Improvement across such a diverse group of countries illustrates that progress can be made, irrespective of geography and wealth. However, increases in neonatal mortality rates in a small number of countries such as Botswana and Venezuela, highlight the urgent need for more targeted support.
Although neonatal mortality rates for the UK have decreased from 3.8 to 2.7 per 1,000 live births over the same period, the UK has plateaued since 2017, lagging the pace of improvement seen in Ireland and Norway, and moving further away from the OECD average. Across OECD countries, Japan has the lowest rate of neonatal mortality. If the UK matched the neonatal mortality rate of Japan, the UK could have had 1,123 fewer neonatal deaths in 2023.
The global rate of deaths due to preterm births (a baby born before 37 weeks of pregnancy) has also declined markedly, from 17.4 per 1,000 live births in 2000 to 7.7 in 2023. Preterm birth is the leading cause of neonatal mortality in the UK, with 1,212 deaths reported in 2023. Although average rates across OECD countries fell by 53 per cent, the figure for the UK was 29 per cent (Figure 16). The data shows that the UK has consistently seen an above-average rate of preterm births since 2003 and has plateaued since 2019.
There are many biological, environmental and social causes of preterm birth. Recommended preventative action focuses on three main areas: improving women’s health during pregnancy, universal screening for risk factors, and referral to specialist clinics for women identified as at risk. Evidence presented to a House of Lord’s Committee reported disparities in preterm birth rates and outcomes between different socio-economic and ethnic groups, and a lack of progress to meet the UK’s target of reducing the rate of preterm births to 6 per cent by 2025.
While many of the recommended preventative actions do not necessarily fall within patient safety, inadequate attention to these factors can place greater strain on maternity and neonatal services already experiencing significant quality and safety concerns.
5.3.3 Waiting times
OECD average waits for most planned procedures fell prior to, and following, the COVID-19 pandemic. The UK experiences higher than average waits for more complex procedures, but further investigation is needed due to the lack of consistently reported data.
In the National State of Patient Safety 2022 Report, we argued that the “the lack of timely and equitable access to care should be considered an urgent patient safety issue”. This followed the challenges of increasing waiting lists for planned care, falls in the diagnosis of some long-term conditions, and significant pressures on emergency services, exacerbated by the COVID-19 pandemic.
Our dashboard contains indicators on waiting times, from specialist assessment to treatment, for seven procedures. Figures 17-23 show the data trends for available OECD countries and compute OECD average trend lines for three distinct time periods: 2000-2019, 2020-2022, and post 2023. This allows us to look at changes before, during and after the effect of the COVID-19 pandemic.
We see that OECD average waiting times for these procedures fell between 2000 and 2019, or remained relatively stable in the case of knee replacements. Understandably, following the advent of the pandemic, waiting times for these (usually) planned procedures increased.
The latest available data suggests a downward trend towards pre-pandemic levels for these procedures, except in the case of coronary artery bypass grafts (a procedure to improve blood flow to the heart using a healthy blood vessel, Figure 20) and trans-urethral prostatectomy (a procedure to remove a section of the prostate gland that is blocking the urethra, Figure 23).
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