1. A UK perspective on the 2014 Commonwealth Fund International Survey Jennifer Dixon Chief Executive The Health Foundation, London.

2. Key findings for the UK Less likely to have any chronic conditions (10th out of 11) and relatively low rates of hospitalisation (10 th out of 11) Access to care generally good: Low access problems because of cost Low use of ED and avoidable ED visits Easy to get out of hours care (10th out of 11) But regular doctor not spending enough time with them (9 th out of 11) Care coordination and safety: not an outlier but percentages showing poor coordination a concern More likely to have guidance and treatment plan and contact from a professional between visits to physician but frequency of care per week low. 2

3. Presentation title set in header 3 UK Context: Relatively low spend on health care

4. 4 UK Context: Relatively high squeeze on spend in UK 2008-12

5. 5 UK Context: Relatively low spend on long term conditions in the UK

6. UK context: Reforms since 2010 Major administrative reorganisation (Health & Social Care Act 2012) [England] High profile scandals (eg Mid Staffordshire Hospital) [England] Stronger regulation of quality of care (England) and initiatives to improve safety [UK] Attempts to develop integrated care (although a particular funding squeeze in primary care) across health and social care (as set out in NHS England’s NHS Five Year Forward View) although slow progress [UK] Efforts to diversify the market in providers of health care [England] 6

7. Major considerations now Achieving higher levels of productivity (from1.5% to 3%) to live within budget projections: reducing waste in hospitals; better integrated care; effective prevention; keeping lid on pay and prices Without further tax contributions: maintaining quality of care and universal access to comprehensive care and thus public and political support Likely severe cutbacks in social care 2015-17 General election May 2015 and prospect of minority government which is unstable Accelerating quality improvement and better operational management at pace and scale 7