The Commonwealth Fund’s survey of the experience of adults with complex care needs, published last week, paints a remarkably positive picture of the NHS. The results show that, of the eleven countries surveyed, the number of patients reporting that they did not use services because of concerns about cost was lowest in the United Kingdom. And while the absence of user charges in the NHS (with the exception of some prescription charges) means that this finding is not surprising, other results are equally encouraging.
For example, the United Kingdom performed best on the co-ordination of care for patients, patient safety, and the way in which patients are engaged in their care. It also performed very well on patient–doctor communications and shared decision-making.
The survey – which included more than a thousand respondents from the UK – also explored whether patients had a regular doctor and a medical home, defined as a regular place of care familiar with patients’ needs. The United Kingdom came out on top on this measure, reflecting the well-established system of primary care in the NHS, with only Switzerland approaching the same level of response.
At a time when the NHS has been in the headlines for the wrong reasons – including well-publicised examples of poor quality hospital care for older people – the survey provides welcome reassurance that many patients are receiving timely care of a high standard. It also underlines that the grass is not always greener on the other side. If other countries, with more generously funded health systems than the NHS, are struggling to match our achievements, it is clear that delivering the right care in the right place at the right time is a universal challenge.
In reading the survey results, I was reminded of The King’s Fund’s response to the coalition government’s white paper on NHS reform, Equity and excellence: Liberating the NHS. In that response, Anna Dixon and I argued that in the light of improvements in performance in the past decade, further reform needed to be proportionate to the outstanding problems. Then, as now, we were concerned that the wide-ranging organisational changes underway were high risk and could detract from the core business of improving patient care.
To make this point is not to argue for the maintenance of the status quo. Rather, it is to make the case that any new reforms must tackle areas in which the NHS clearly needs to improve, and to enable other priorities – like rising to the Nicholson challenge of finding £20bn in efficiency savings – to be addressed. Readers of the Commonwealth Fund’s survey, especially those from other countries, must be puzzled as to why radical changes are needed when the NHS appears to be doing so well.