Reported improvements in the UK tracked with recent reforms Cambridge Centre for Health Services Research University of Cambridge

Reported improvements in the UK tracked with recent reforms: Overall rating Cambridge Centre for Health Services Research University of Cambridge (n.b. minor wording changes in 2011) System works well, only minor changes needed 30%36%51% System needs to be completely rebuilt 14%12%2% Overall rating of care excellent or very good 63%62%81%

Reported improvements in the UK tracked with recent reforms: Coordination Cambridge Centre for Health Services Research University of Cambridge (n.b. minor wording changes in 2011) Coordination problem (either tests results not available or duplicated) 19%21%13% Got the wrong medicine or wrong dose 10%8%2% Medical mistake in your treatment or care 12%10%4%

Reported improvements in the UK tracked with recent reforms: Access Cambridge Centre for Health Services Research University of Cambridge Same day / next day appointment when you were sick (n.b. minor wording changes between years) 61% 80% Very difficult to get care at night or weekends 22%21%4% Wait less than four weeks for a specialist appointment 32%44%80%

How can we explain these results Major policy focus on reducing specialist waiting time. Policy focus and financial incentives to reduce waiting time for primary care appointments. Continued focus on primary care as building block of healthcare Increased use of electronic records Initiatives to improve coordination of care: mostly primary care led, e.g. disease management protocols in P4P scheme, case management of frail elderly (….surprise) (….and do we need another major reform?) Cambridge Centre for Health Services Research University of Cambridge

Complex patients dont necessarily account for a disproportionate share of spend – just a high proportion Cambridge Centre for Health Services Research University of Cambridge

John Øvretveit (2011) asked the question Does clinical coordination improve quality and save money Answer: Yes it can, but that the answer depends on the approach used, how well its implemented and the environment in which its introduced. Cambridge Centre for Health Services Research University of Cambridge

Summary of a systematic review on the effectiveness of interventions to improve coordination in health care 55% of interventions improved care 45% of interventions improved patient experience 18% of interventions reduced cost completed/stream-four-translating-evidence-policy/coordination-care-within Cambridge Centre for Health Services Research University of Cambridge