An article (in the 27th British Social Attitudes report) examined satisfaction with the National Health Service, and how it had varied over time and between different groups. In 1997, only one-third of people (34 per cent) had been satisfied with the NHS, the lowest level since the first survey in 1983: but by 2009, just before the Labour government left office, satisfaction stood at 64 per cent – the highest level recorded by the survey.
Source: John Appleby and Ruth Robertson, <:'A healthy improvement? Satisfaction with the NHS under Labour', in Alison Park and Elizabeth Clery (eds.), British Social Attitudes: The 27th Report, SAGE Publications
Links: Summary | NatCen press release
Date: 2010-Dec
The inspectorate for healthcare and social care said that most women felt positive about maternity care services, with some 'encouraging improvements' since 2007: but information and support still needed to improve.
Source: Women's Experiences of Maternity Care in England: Key findings from the 2010 NHS trust survey, Care Quality Commission
Links: Report | CQC press release | DH statement | NCT press release | RCM press release | RCN press release | BBC report | Guardian report | Public Finance report | Children & Young People Now report
Date: 2010-Dec
The government published (following consultation) the first National Health Service 'outcomes framework' in England. In the future the NHS would focus on those outcomes that mattered most to patients, rather than on achieving centrally driven process targets that 'got in the way' of patient care.
Source: The NHS Outcomes Framework 2011/12, Department of Health
Links: Framework | Technical paper | Response to consultation | Hansard | DH press release | Labour Party press release | BMA press release | CMH press release | Kings Fund press release | Telegraph report
Notes: Consultation document
Date: 2010-Dec
An audit report said that hospital productivity in England had fallen over the previous 10 years. Hospitals had used their increased resources to deliver against national priorities: but they needed to provide more leadership, management, and clinical engagement to optimize the use of additional resources and deliver value for money.
Source: Management of NHS Hospital Productivity, HC 491 (Session 2010-11), National Audit Office/TSO
Links: Report | NAO press release | Kings Fund press release | Guardian report | Public Finance report | Telegraph report
Date: 2010-Dec
An audit report in Scotland said that in 2009-10 all National Health Service bodies had met their financial targets. But patients' demands on services were increasing; and cost pressures such as pay, fuel, and drug prescribing were expected to rise. At the same time, the year-on-year increase in funding for the health service was slowing down. This meant that all NHS bodies would have to find significantly more financial savings to deliver the same level of quality provided in previous years.
Source: Financial Overview of the NHS in Scotland 2009/10, Audit Scotland for Accounts Commission and Auditor General
Links: Report | Audit Scotland press release | BBC report
Date: 2010-Dec
A think-tank report called for radical changes in the delivery of mental health services in England to improve patient care and increase productivity. It recommended: a reduction in unnecessary bed use in hospitals and psychiatric units by providing better community-based services; a significant reduction in the number of patients placed in facilities outside their local area; and improvements in services for older people and those with long-term conditions who also had mental health problems.
Source: Chris Naylor and Andy Bell, Mental Health and the Productivity Challenge: Improving quality and value for money, King's Fund/Centre for Mental Health
Links: Report | King's Fund press release | CMH press release | RCPsych press release | Community Care report | BBC report
Date: 2010-Dec
A report examined first-hand accounts of the hospital care of older patients. It highlighted serious failings in standards of nursing care, poor communication with relatives, and an ineffective complaints-handling system.
Source: Listen to Patients, Speak Up for Change, Patients Association
Links: Report | Patients Association press release | RCN press release | BBC report | Nursing Times report
Date: 2010-Dec
The government began consultation on proposals for a public health outcomes framework in England. It considered how to: protect the population's health from major emergencies; tackle factors that affected health and well-being and health inequalities; help people to live healthy lifestyles and make healthy choices; prevent ill-health; and prevent people from dying prematurely.
Source: Proposals for a Public Health Outcomes Framework, Department of Health
Links: Consultation document | Hansard | DH press release
Date: 2010-Dec
An independent review of palliative care services (led by Tom Hughes Hallett) published its interim report. It said that the National Health Service in England had failed to take responsibility for ensuring good end-of-life care, leading to a 'postcode lottery' in funding and service quality.
Source: Interim Report, Palliative Care Funding Review
Links: Report | Review press release | Marie Curie press release | BBC report
Date: 2010-Dec
A report said that hospitals in England were guilty of 'organizational failures' in dealing with the needs of elderly surgery patients. Only 38 per cent of patients over 80, who later died in hospital within 30 days of surgery, had received 'good care'.
Source: Kathy Wilkinson et al., An Age Old Problem: A review of the care received by elderly patients undergoing surgery, National Confidential Enquiry into Patient Outcome and Death
Links: Report | Summary | Age UK press release | NHS Confederation press release | Patients Association press release | Telegraph report
Date: 2010-Nov
A study found that the majority of women were pleased with the care that they had received from the National Health Service during pregnancy and childbirth: but there were important areas where improvements could still be made.
Source: Maggie Redshaw and Katriina Heikkila, Delivered with Care: A national survey of women's experience of maternity care 2010, National Perinatal Epidemiology Unit/University of Oxford
Links: Report | Oxford University press release
Date: 2010-Nov
A report said that deaths in hospitals in England continued to fall, dropping 7 per cent between 2008-09 and 2009-10 in crude terms. The gap between the highest and lowest hospital-standardized mortality ratios had narrowed. Safety standards had improved, with higher rates of compliance with safety alerts and better reporting of errors. But 19 hospitals had significantly high overall mortality ratios, and 4 had significantly high ratios for deaths after surgery.
Source: Hospital Guide 2010: What makes a good hospital?, Dr Foster Ltd
Links: Report | Dr Foster press release | CQC press release | Patients Association press release | NHS Confederation press release | BBC report | Telegraph report | Guardian report
Date: 2010-Nov
A new method was published (following a review) for calculating and using hospital mortality ratios across the National Health Service in England – called the 'summary hospital-level mortality indicators' (SHMIs). The indicators were intended to compare the observed number of deaths that actually occurred in hospitals with a statistical estimate of the number of deaths that might have been expected, based upon national average death rates and the particular characteristics of the patients treated in each hospital.
Source: Report from the Steering Group for the National Review of the Hospital Standardised Mortality Ratio, Department of Health
Links: Report | Consensus statement | DH press release
Date: 2010-Nov
A paper said that the National Health Service in England could cut expenditure by £3.2 billion per annum without reducing the number of patients treated if all its regions were as productive as the best.
Source: Chris Bojke, Adriana Castelli, Mauro Laudicella, Andrew Street and Padraic Ward, Regional Variation in the Productivity of the English National Health Service, Research Paper 57, Centre for Health Economics/University of York
Links: Paper | York University press release
Date: 2010-Oct
A think-tank report said that National Health Service patients were being denied potentially better, more timely treatment because of a 'closed shop' culture that demanded loyalty to the 'family' of NHS hospital providers. Existing providers used their muscle and connexions to keep providing services even when faster, higher-quality care was on offer elsewhere.
Source: Laura Brereton and James Gubb, Refusing Treatment: The NHS and market-based reform, Civitas
Links: Civitas press release | Telegraph report | BBC report
Date: 2010-Oct
An article examined whether responses to questions in surveys of patients that purported to assess the performance of general practices or doctors reflected differences between practices, doctors, or the patients themselves. In assessing the performance of general practices, it was better to ask patients about their actual experiences of care rather than ask for satisfaction ratings.
Source: Chris Salisbury, Marc Wallace and Alan Montgomery, 'Patients' experience and satisfaction in primary care: secondary analysis using multilevel modelling', British Medical Journal, 12 October 2010
Links: Article | Abstract | Bristol University press release
Date: 2010-Oct
A study examined the impact of a range of incentives in primary care on professional behaviours and performance.
Source: Ruth McDonald, Sudeh Cheraghi-Sohi, Martin Tickle, Martin Roland and Tim Doran, The Impact of Incentives on the Behaviour and Performance of Primary Care Professionals, National Institute for Health Research Service Delivery and Organisation
Date: 2010-Sep
An article estimated the potential reduction in population mortality from implementation of the pay-for-performance contract in primary care in England. The contract might have delivered a substantial health gain: but the gain was limited by performance targets for full payment being set lower than typical baseline performance.
Source: Robert Fleetcroft et al., 'The UK pay-for-performance programme in primary care: estimation of population mortality reduction', British Journal of General Practice, Volume 60 Number 578
Links: Abstract
Date: 2010-Sep
A government-commissioned review said that a 'huge cultural shift' was needed in the National Health Service in England in order to ensure that children got the right care. It said that services were 'mediocre', and called for specialist training for family doctors and extra investment in services. The government responded by publishing an 'engagement document' setting out a new vision for the health of children and young people – one in which services would be personalized to individual needs.
Source: Ian Kennedy, Getting It Right for Children and Young People: Overcoming cultural barriers in the NHS so as to meet their needs, Department of Health | Achieving Equity and Excellence for Children: How liberating the NHS will help us meet the needs of children and young people, Department of Health
Links: Report | Review press release | Engagement document | DH press release | EDCM press release | NCB press release | RCN press release | Children & Young People Now report | Guardian report | BBC report
Date: 2010-Sep
An article examined the comparative performance of small family doctor practices under the pay-for-performance 'Quality and Outcomes Framework'. Small practices were represented among both the best and the worst practices in terms of achievement of clinical quality targets. The effect of the pay-for-performance scheme appeared to have been to reduce variation in performance, and to reduce the difference between large and small practices.
Source: Tim Doran, Stephen Campbell, Catherine Fullwood, Evangelos Kontopantelis and Martin Roland, 'Performance of small general practices under the UK's Quality and Outcomes Framework', British Journal of General Practice, Volume 60 Number 578
Links: Abstract
Date: 2010-Sep
A paper examined how enhanced skills could improve productivity and performance in the healthcare sector.
Source: Kate Crosswaite, Nicola Hall and Gary Lawson, with Ian Wheeler and Fionnuala Palmer, Understanding the Contribution of Skills to Productivity in the UK Health Sector, Skills for Health
Links: Paper
Date: 2010-Aug
A paper examined the impact of competition on hospital outcomes. Patients discharged from hospitals located in markets where competition was more feasible were less likely to die, had a shorter length of stay, and were treated at the same cost.
Source: Martin Gaynor, Rodrigo Moreno-Serra and Carol Propper, Death by Market Power: Reform, competition and patient outcomes in the National Health Service, Working Paper 242, Centre for Market and Public Organisation/University of Bristol
Links: Working paper
Date: 2010-Jul
A think-tank report examined the gap between the likely available funding for the National Health Service and the funding required to achieve the progress projected by the Wanless report in 2002. It looked at the scale of the problem, strategies for managing the cost and demand pressures, and strategies for improving productivity.
Source: John Appleby, Chris Ham, Candace Imison and Mark Jennings, Improving NHS Productivity: More with the same not more of the same, King s Fund
Links: Report
Date: 2010-Jul
The government began consultation on a new framework of national outcome goals that patients and the public could use to judge the overall performance of the National Health Service in England. It said that the aim was to refocus the NHS on the outcomes achieved for patients rather than the 'process targets of the past' that had no clinical justification.
Source: Transparency in Outcomes: A framework for the NHS, Department of Health
Links: Consultation document | Hansard | DH press release
Date: 2010-Jul
Researchers examined whether the introduction of patient choice and hospital competition in the English National Health Service in January 2006 had prompted hospitals to become more efficient.
Source: Zack Cooper, Stephen Gibbons, Simon Jones and Alistair McGuire, Does Hospital Competition Improve Efficiency? An analysis of the recent market-based reforms to the English NHS, DP988, Centre for Economic Performance/London School of Economics
Links: Paper
Date: 2010-Jul
A report questioned whether higher health spending in Scotland compared with England had made any difference to health outcomes.
Source: John McLaren, Jo Armstrong and Richard Harris, Spending on Health, Scottish Government Budget Options Briefing 3, Centre for Public Policy for Regions/University of Glasgow, with KPMG
Links: Report | BBC report
Date: 2010-Jun
An audit report reviewed the data systems used to support delivery of the Labour government's public service agreement 18 – to 'promote better health and wellbeing for all' – over the period from 2008.
Source: Review of the Data Systems for Public Service Agreement 18, National Audit Office
Links: Report
Date: 2010-Jun
An audit report reviewed the data systems used to support delivery of the Labour government's public service agreement 19 – to 'ensure better care for all' – over the period from 2008.
Source: Review of the Data Systems for Public Service Agreement 19, National Audit Office
Links: Report
Date: 2010-Jun
An audit report in Northern Ireland said that the performance of the health and social care sector had undergone a 'step change improvement' in recent years. On measures such as waiting times, and the prevention/treatment of heart disease and cancer, the sector was delivering a markedly better service than five years previously.
Source: General Report on the Health and Social Care Sector by the Comptroller and Auditor General for Northern Ireland – 2009, Northern Ireland Audit Office/TSO
Links: Report | NIAO press release
Date: 2010-Jun
The new Conservative-Liberal Democrat coalition government published a revision to the operating framework for the National Health Service in England for 2010-11. The changes included: removal of targets around access to primary care; removal of the 18 weeks referral-to-treatment target; and a reduction of the 4-hour accident and emergency target threshold from 98 per cent to 95 per cent.
Source: Revision to the Operating Framework for the NHS in England 2010/11, Department of Health
Links: Framework | DH press release | Hansard | NHS Confederation press release | Kings Fund press release | BMA press release | Patients Association press release | RCN press release | Alzheimers Society press release | Guardian report | BBC report | Pulse report (1) | Pulse report (2)
Date: 2010-Jun
An article presented new estimates of publicly funded healthcare outputs, inputs, and productivity for the period 1995-2008 – including a downward revision for 2007.
Source: Cristina Penaloza, 'Healthcare productivity', Economic & Labour Market Review, June 2010, Office for National Statistics
Links: Article
Date: 2010-Jun
A study examined the nature and dynamics of culture change in the National Health Service, with a particular emphasis on how organizational culture linked to healthcare performance.
Source: Russell Mannion et al., Changing Management Cultures and Organisational Performance in the NHS (OC2), National Institute for Health Research/London School of Hygiene & Tropical Medicine
Links: Report
Date: 2010-May
A report examined the extent, type, and causes of failures in reliability in different healthcare systems.
Source: Susan Burnett et al., How Safe Are Clinical Systems? Primary research into the reliability of systems within seven NHS organisations and ideas for improvement, Health Foundation
Links: Report | Health Foundation press release
Date: 2010-May
The inspectorate for healthcare and social care published the results of the 2009 NHS Inpatient Survey, covering 162 hospital trusts in England. It highlighted big improvements in cleanliness and a decline in mixed-sex accommodation: but progress had been disappointing in some important aspects of care and in some cases the experience of patients had got worse.
Source: National NHS Patient Survey Programme: Survey of Adult Inpatients 2009, Care Quality Commission
Links: Report | CQC press release | NHS Confederation press release | RCN press release
Date: 2010-May
A paper examined the causal impact of competition on management quality in the hospital sector in England. It was found that management quality – measured using a new survey tool – was strongly correlated with financial and clinical outcomes.
Source: Nicholas Bloom, Carol Propper, Stephan Seiler and John Van Reenen, The Impact of Competition on Management Quality: Evidence from public hospitals, DP983, Centre for Economic Performance/London School of Economics
Links: Paper
Date: 2010-May
An article reported on research designed to identify the key characteristics of high-performing healthcare commissioning organizations. In order for organizations to become high-performing they needed to be able to reconstruct the criteria of performance for the healthcare system deployed by the government and other key stakeholders.
Source: Helen Dickinson, Edward Peck and Joan Durose, 'Efficiency, effectiveness and efficacy: towards a framework for high-performance in healthcare commissioning', Public Money and Management, Volume 30 Issue 3
Links: Abstract
Date: 2010-May
A think-tank report examined the progress made by the National Health Service between 1997 and 2010. The main successes included: significant reductions in waiting times and improved access to primary care; less variation in access to drugs and treatment; significant reductions in rates of hospital-acquired infection; sustained reductions in deaths due to cancer and cardiovascular disease; and sustained reductions in rates of smoking. But the National Health Service needed to change rapidly if it were to meet the big challenges it faced in the future.
Source: Ruth Thorlby and Jo Maybin (eds.), A High-Performing NHS? A review of progress 1997-2010, King's Fund
Links: Report | King's Fund press release | BBC report | Nursing Times report | Community Care report
Date: 2010-Apr
A think-tank report highlighted the potential of 'quality accounts' – reports for the public on the quality of National Health Service services – to improve local public accountability: but this would only be possible if scepticism about their value could be overcome through genuine public involvement.
Source: Catherine Foot and Shilpa Ross, Accounting for Quality to the Local Community: Findings from focus group research, King's Fund
Links: Report | King's Fund press release
Date: 2010-Apr
A paper said that healthcare spending had increased by nearly 7 per cent per year in real terms in the previous decade – the largest ever sustained increase in the history of the National Health Service. Clinical performance and patient satisfaction had increased substantially, and waiting times had dropped significantly, since Labour had been in power. But the NHS still lagged behind other European countries on several quality indicators and in particular on cancer mortality.
Source: Zack Cooper and Alistair McGuire, Health: Higher Spending Has Improved Quality, But Productivity Must Increase, Centre for Economic Performance/London School of Economics
Links: Paper
Date: 2010-Apr
An article said that standardized mortality rates were a poor measure of the quality of hospital care, and should not be a trigger for public inquiries.
Source: Richard Lilford and Peter Pronovost, 'Using hospital mortality rates to judge hospital performance: a bad idea that just won't go away', British Medical Journal, 20 April 2010
Links: Article
Date: 2010-Apr
An audit report said that the National Health Service in Scotland had made big changes in how it managed waiting lists since 2008, and that these had made the system fairer for patients.
Source: Managing NHS Waiting Lists: A review of new arrangements, Audit Scotland for Accounts Commission and Auditor General
Links: Report | Audit Scotland press release | Scottish Government press release | BBC report
Date: 2010-Mar
A report said that economic challenges would probably slow the rate of future reform of the National Health Service, with larger projects being delayed. It suggested that cultural change within the NHS, rather than structural or institutional change, might be the best way to make performance improvements in the period ahead.
Source: Andrea Chipman, Doing More With Less: British healthcare to 2013, Economist Intelligence Unit
Links: Report | BMI Healthcare press release | Nursing Times report
Date: 2010-Mar
A think-tank report highlighted the potential for patient-reported outcome measures (PROMs) to transform the funding and management of healthcare. Primary care trusts could strengthen their commissioning by using PROMs to assess value for money, and clinical teams could use them to benchmark and improve their performance.
Source: Nancy Devlin and John Appleby, Getting the Most out of PROMs: Putting health outcomes at the heart of NHS decision-making, King's Fund
Links: Report | King's Fund press release | OHE press release
Date: 2010-Mar
A paper reviewed the literature on amenable mortality (deaths considered avoidable due to medical intervention). It concluded that there was insufficient evidence on how much of the decline in amenable mortality could be attributed to the healthcare system, and therefore for its use as an indicator of healthcare quality.
Source: Sophia Kamarudeen, Amenable Mortality as an Indicator of Healthcare Quality: A literature review, UK Centre for the Measurement of Government Activity/Office for National Statistics
Links: Paper
Date: 2010-Mar
Three linked papers examined recent trends in the productivity of publicly funded healthcare services.
Source: Maria-Cristina Penaloza and Richard Wild, Public Service Output, Input and Productivity: Healthcare, UK Centre for the Measurement of Government Activity/Office for National Statistics | Michael Hardie, Maria-Cristina Penaloza, Richard Wild and Katherine Mills, Public Service Output, Inputs and Productivity: Healthcare – Extended Analysis, UK Centre for the Measurement of Government Activity/Office for National Statistics | Maria-Cristina Penaloza, Public Service Output, Inputs and Productivity: Healthcare Triangulation, UK Centre for the Measurement of Government Activity/Office for National Statistics
Links: Paper (1) | Paper (2) | Paper (3) | Nursing Times report
Date: 2010-Mar
A report (based on a seminar held in 2009) examined how the National Health Service could learn from high-performing health organizations in the delivery of quality.
Source: Chris Ham, Learning from the Best: What the NHS needs to do to implement high quality care for all, NHS Institute for Innovation and Improvement
Links: Report
Date: 2010-Feb
The inspectorate for healthcare and social care began consultation on proposals to promote high-quality health and social care through a new approach to assessments in 2010-11. The assessments would apply to all 152 local councils, 392 National Health Service trusts, and 24,000 adult social care providers. There would be a move away from an overall score for councils as commissioners of social care and primary care trusts as commissioners of healthcare: instead, parts of the assessments would be scored separately to provide detailed information about the quality of specific areas of care. Similarly, it was proposed to separate scored assessments of the quality of care provided by NHS Trusts and PCT providers.
Source: Assessments of Quality in 2010/11: Our proposals for the assessment of commissioners and providers of health and adult social care, Care Quality Commission
Links: Consultation document | CQC press release | Guardian report | Community Care report
Date: 2010-Feb
A report examined lesbian and bisexual women's experiences of breast cancer treatment, support, and care. Many felt that existing cancer support groups were not accessible to them; they often felt excluded by topics of conversation or the environment.
Source: Julie Fish, Coming Out About Breast Cancer: Lesbian and bisexual women's experiences of breast cancer, Health Policy Research Unit/De Montfort University
Links: Report | De Montfort press release | LGF report
Date: 2010-Feb
A report by a committee of the Northern Ireland Assembly said that the health of Northern Ireland people had improved over the previous decade: but it expressed concern at the inequalities, in terms of life expectancy and quality of life, between people living in the most and least deprived areas.
Source: Report on the Performance of the Health Service in Northern Ireland, Eighth Report (Session 2009-10), Northern Ireland Assembly Public Accounts Committee/TSO
Links: Report | NIA press release | BBC report
Date: 2010-Feb
A report described the system for the early detection and prevention of serious failures in the National Health Service, and made a series of recommendations for improvements.
Source: National Quality Board, Review of Early Warning Systems in the NHS: Acute and community services, Department of Health
Links: Report | CQC press release
Date: 2010-Feb
A study examined links between the 2007 National Health Service surveys of staff and of acute trust inpatients. There were a large number of associations between the two surveys. Organizations where staff had clear, planned goals were more likely to have patients who reported positive experiences of communication. The more staff who had had health and safety training, the better the patient perceptions of greater conscientiousness and availability of staff. Patient perceptions of staffing levels and the respect and dignity shown towards staff were correlated with employees' feelings of work pressure and staffing levels.
Source: Jeremy Dawson, Does the Experience of Staff Working in the NHS Link to the Patient Experience of Care? An analysis of links between the 2007 acute trust inpatient and NHS staff surveys, Department of Health
Links: Report
Date: 2010-Feb
A report said that over 300 National Health Service trusts in England (around three-quarters of all trusts) had not complied with the required actions in at least one patient safety alert for which the deadline had already passed. (Patient safety alerts are issued by the National Patient Safety Agency and contain required actions that all relevant NHS trusts are obliged to implement by the deadline given.)
Source: "Adding Insult to Injury": NHS failure to implement patient safety alerts, Action Against Medical Accidents
Links: Report | AvMA press release | Liberal Democrats press release | Nursing Times report | Guardian report
Date: 2010-Feb
A think-tank report said that greater use of quality measures in the National Health Service had real potential for improving the quality of provision: but care needed to be taken to avoid misleading patients, distorting priorities, and damaging staff morale.
Source: Veena Raleigh and Catherine Foot, Getting the Measure of Quality: Opportunities and challenges, King's Fund
Links: Report | Pulse report
Date: 2010-Jan
A report said that the National Health Service in England spent less on healthcare and had fewer doctors, nurses, and managers per head of population than the health services in the devolved countries (Scotland, Wales, and Northern Ireland): but that it was making better use of the resources it had in terms of delivering higher levels of activity, crude productivity of its staff, and lower waiting times.
Source: Sheelah Connolly, Gwyn Bevan and Nicholas Mays, Funding and Performance of Healthcare Systems in the Four Countries of the UK Before and After Devolution, Nuffield Trust
Links: Report | Summary | Nuffield Trust press release | NHS Confederation press release | BBC report | Telegraph report | Nursing Times report
Date: 2010-Jan