News and Comment

New research suggests NHS does well by international comparison

Wednesday 16 November 2011


The findings from the Commonwealth Fund’s 2011 International Health Survey demonstrate yet again the falsity of the notion that the NHS provides poor quality care and costs too much. While our system obviously isn’t perfect, the overall picture does beg a handful of questions, not least of which: what are we really trying to fix with the current set of NHS reforms?

Released last week, the Fund’s survey results compared the care received by patients with complex needs (‘sicker adults’) in eleven countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the U.S.

Patients were questioned about their experiences accessing health services and specialist care; out-of-pocket costs; coordination of care across different settings; and communication and engagement by their doctors.

There is clearly a mis-match between how we view the NHS and the picture emerging from the Commonwealth Fund’s findings. When compared to other countries, the UK’s health system has distinct advantages.

How does the UK compare?

  • In terms of health care spending, the UK is at the low end: $3487 per capita or 9.8% of GDP – less than other Western European countries and markedly less than the US system, which comes in at a staggering $7960 per capita and 17.4% of GDP.
  • Patients in the UK are the least likely to skip visits to the doctor, tests or treatments because of an inability to pay for care, and only 1% of UK respondents reported spending more than $1000 of their own money to pay for care.
  • Compared to the other countries, the NHS performed best of all in terms of patients accessing care when they need it. Nearly four of every five UK respondents reported getting an appointment to see a doctor on the same or next day. Only 2% waited six days or more. Four out of five patients waited less than a month for specialist care. And only one in five patients reported difficulty accessing our-of-hours care.
  • By the Commonwealth Fund’s definition, three-quarters of patients have a medical home – the highest among the eleven countries. Nearly nine of every ten UK patients with a medical home rank their health care as ‘excellent’ or ‘very good’ – again, the highest figure.
  • The UK appears to be doing well in care coordination and continuity. While the picture isn’t perfect, the comparisons suggest the UK’s doctors are more likely to share information and ensure appropriate follow-up care after hospital discharge. The survey also suggests fewer patient safety problems, such as lab test delays and medication errors.

The relationship between UK patients and their doctors appears to be getting healthier as well, suggesting a real breakthrough in previously observed paternalistic attitudes and practices. Over seven of every ten UK respondents reported that their doctors spend enough time with them, encourage them to ask questions and explain treatments in an understandable way. As a measure of shared decision-making, four of every five respondents report their specialist doctors give them opportunities to ask questions, make treatment choices and involve them in decisions about their care.

How have things changed over time?

The last time the Commonwealth Fund surveyed ‘sicker adults’ was in 2005. At that time, the previous government’s health reforms were just bedding down, and patients were much more likely to say the NHS was ‘fair’ or ‘poor’, citing problems with care coordination, safety and engagement with their doctors. In comparing the 2005 and 2011 survey results, it does appear that care for patients with chronic conditions has improved, and that the incentives in policy and payment reforms made a real difference to patient experiences.

Fundamentally, the Commonwealth Fund survey illustrates how problems of quality and cost are not unique to the NHS. All the health systems in the survey face similar challenges of integrating and coordinating care for patients with chronic health conditions. And there are still many miles to go before true shared decision-making is the norm rather than the exception.

Drawing all these findings together, one is struck by the fairness, cost effectiveness and quality of care that defines the NHS. While our system isn’t perfect, the overall picture does beg a handful of questions: What are we really trying to fix with the current set of NHS reforms? Will the doctor-led model of commissioning achieve anything more for patients than tinkering around the edges? And will the financial pressures squeezing the health system – the sheer magnitude of savings that have to be found – distract us from maintaining our focus on improving patient experiences?