Commonwealth Fund survey: if the NHS is doing well, why is it changing?

This content relates to the following topics:

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.


Sunita Berry

Comment date
25 November 2011
Well if you were only to consider the improvements made in terms of cardiovascular services - which constitute a third of all mortality, then England has made huge strides (the UK as a whole has been less successful - but then devolution does mean that you can do things differently). But the government can only see unsubstantiated claims from consultancies which have access to the department the even the most senior partners in the NHS don't. In the last 4 years alone, three programmes 'PCT fitness for Purpose', 'World Class Commissioning' and FES support for commissioning' have poured many millions into the coffers of the consultancies. The programmes are just rehashed versions of each other, and now the goverment promises yet another programme of commissioning support for CCGs - probably with the same firms. And then we have people complaining about the number of managers in the NHS!!!!

David Booth

Comment date
18 November 2011
I continue to be astounded at how the case for these reforms has been presented, with such superficial, selective analysis and shallow arguments for the proposed changes - now essentially 'de facto' because of their implementation in advance of legislation: such a 'bulldozer' approach that belittles both the importance of the NHS in our society and the views and experience of those that serve within it. The NHS is not perfect, it needs to change and improve, and it's a complex system - but that is best tackled with depth of analysis and understanding, and addressing the challenges that really matter. One suspects that ideology is driving the current reforms, not logic nor open debate. I feel for those working in the NHS undergoing yet more radical changes, and I fear for whatever the result might be for all of us as patients.

James Bunt

Gordian Management
Comment date
16 November 2011
Dr Tomlinson, this is very interesting, thank you. I have wondered for a long time who was advising the DH. I have worked in parts of the NHS where change has been in progress, such as ISTCs and Polyclinics, and alongside McKinseys. Their lack of practical experience and inability to understand detail in the system worried me and my suspicion they were involved has been confirmed. I agree with Chris's analysis, the NHS is not perfect but in context improvements such as hitting 18 weeks and 4 hrs, are mind blowing examples of successful change. Why then the wholesale change?

Jonathon Tomlinson

Comment date
15 November 2011
Would you like to comment on the Nicholson challenge (McKinsey challenge?) Given that the NHS has a world reputation for parsimony and has only very recently reached average european spending on health, most people are bewildered that the McKinsey report (which wouldn't have passed muster if an undergraduate had handed it in) is the basis for what Stephen Dorrell has described as the revolutionary part of the reforms and a Tory Peer told me would 'destroy the NHS'

Add your comment