American think-tank puts NHS on top


Care is accessible, coordinated and focused on patients

Patients living with health problems and complex care needs fare better in the UK than in other countries, according to a new survey, which suggests that the NHS system brings benefits through integrated care and the GP system.

The findings may lend weight to the case of opponents of the Government’s NHS reforms, who argue that the system is working well and does not need to be overhauled.

The Commonwealth Fund, a thinktank based in the United States, surveyed patients with complex care needs in 11 countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States). This included more than 18,000 adults who were in fair or poor health, had recently been hospitalised or had major surgery, or had a serious illness or injury in the past year.

Across many areas explored in the survey, the UK came out on top, including the ability to see a doctor or nurse quickly and the level to which services are patient-centred, with doctors engaging openly with patients.

The Commonwealth Fund previously found that care is the UK was affordable, accessible and equitable when compared to other countries.

The findings highlighted the high level of access to care enjoyed by patients in the UK. In the US, more than one of four (27%) were unable to pay or encountered serious problems paying medical bills in the past year, compared with between 1% in the UK. However, 11% of UK respondents did report having cost-related access problems in the past year.

Almost four in five (79%) UK respondents said they saw a doctor or nurse the last time they were sick the same or next day – the highest proportion of respondents from any country. Although 21% said that obtaining after-hours care was “somewhat or very difficult”, this was the lowest percentage out of all the countries.

The survey also highlights the benefits of a health system founded on general practice. Three-quarters of UK respondents (74%) said they had a regular doctor who was accessible, knew their medical history and helped to coordinate care, compared to around half in most other countries.  Against this backdrop, the UK came out on top for sharing information among providers of care and avoiding gaps in transferring people from hospital back home. It also scored highly for staff talking to patients about their condition and helping them to manage it.

The study authors note that, compared to earlier surveys, UK respondents are reporting improvements in care access, management, and communication. They suggest that this might reflect recent reforms including the implementation of patient surveys to provide feedback to clinicians and the use of financial incentives to encourage doctors to coordinate care. They note however, that the NHS may now need to focus on measuring outcomes as well as process (such as waiting times).

In a speech likely to rile the NHS, particularly in the light of a recent report challenging the Government's claims about poor cancer outcomes, Health Secretary Andrew Lansley told a Washington meeting convened to discuss the study that he was committed to reforming "a system long characterised by 'command and control', bureaucratic processes, lack of choice and innovation, limited choice and poor relative outcomes."

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