A report presented data on the performance of National Health Service hospitals in England. 29 per cent of hospital beds were occupied by patients who were admitted to hospital unnecessarily and could have been treated elsewhere, leading to serious problems of overcrowding.
Source: Fit for the Future?, Dr Foster Ltd
Links: Report | Labour Party press release | NHS Confederation press release | RCN press release | RCP press release | BBC report | Guardian report | Telegraph report
Date: 2012-Dec
A paper examined the impact of relaxing constraints on patient choice in the English National Health Service. It was found that patients became more responsive to clinical quality. Sicker patients and better-informed patients were more affected. Increased demand responsiveness led to a significant reduction in mortality and an increase in patient welfare. Hospitals acquired potentially large incentives to improve their quality of care, and there was 'suggestive' evidence that hospitals responded strongly.
Source: Martin Gaynor, Carol Propper, and Stephan Seiler, Free to Choose? Reform and demand response in the English National Health Service, DP1179, Centre for Economic Performance (London School of Economics)
Links: Paper
Date: 2012-Dec
An article said that awareness of the importance of being open was high among patient safety managers in English National Health Service Trusts: but there was still considerable scope for improvement in the management of the after-effects of patient safety incidents. Fear of litigation, and worry about being accused of malpractice, were among the most important reasons why NHS trusts were failing to hold open disclosure meetings with patients or their families.
Source: Anna Pinto, Omar Faiz, and Charles Vincent, 'Managing the after effects of serious patient safety incidents in the NHS: an online survey study', BMJ Quality & Safety, Volume 21 Issue 12
Links: Abstract | Telegraph report
Date: 2012-Dec
A paper examined whether greater competition between hospitals was associated with higher quality. The direction and strength of the association depended on the quality measure: there was a negative association between competition and some mortality indicators but not others, a positive association between competition and some readmission rates but not others, and a negative association between competition and patients' satisfaction. Further theoretical and empirical modelling was required.
Source: Hugh Gravelle, Rita Santos, Luigi Siciliani, and Rosalind Goudie, Hospital Quality Competition under Fixed Prices, Research Paper 80, Centre for Health Economics (University of York)
Links: Paper
Date: 2012-Nov
The inspectorate for healthcare and social care said that pressures on care services were increasing the risks of poor or unsafe care for vulnerable people. 1 in 10 National Health Service hospitals in England failed to treat people with the respect that they deserved and failed to involve them in decisions about their care. 15 per cent of social care services were also not providing care that respected people.
Source: The State of Health Care and Adult Social Care in England in 2011/12, HC 763, Care Quality Commission, TSO
Links: Report | CQC press release | ARC press release | MHF press release | Mind press release | NHS Confederation press release | NHS Partners Network press release | Labour Party press release | Patients Association press release | RCN press release | 2020health blog post | BBC report | Community Care report | Guardian report | Public Finance report | Telegraph report
Date: 2012-Nov
An article said that the introduction of pay for performance in all National Health Service hospitals in one region of England had been found to be associated with a clinically significant reduction in mortality.
Source: Matt Sutton, Silviya Nikolova, Ruth Boaden, Helen Lester, Ruth McDonald, and Martin Roland, 'Reduced mortality with hospital pay for performance in England', New England Journal of Medicine, Volume 367 Number 19
Links: Abstract | Manchester University press release | Telegraph report
Date: 2012-Nov
An audit report said that incentive schemes aimed at improving quality of service in the National Health Service had had a 'variable' impact. Although the concept of 'best practice tariffs' had strong support, NHS organizations said that they were not a driving force for local improvement.
Source: James Peskett, Emma Knowles, Philippa Lynch, John Sandhu, Nelson Johnson, Richard Edwards, and Sarah Halling, Best Practice Tariffs and their Impact, Audit Commission
Links: Report | Summary | Nottingham University press release
Date: 2012-Nov
A study reviewed the health system in Wales. Wales faced a period of financial retrenchment greater than in other parts of the United Kingdom as a result of the Welsh Government's decision not to afford the same degree of protection to health spending as that granted elsewhere. The health system in Wales continued to face some structural weaknesses that had proved resistant to reform for some time. However, there had been substantial improvement in service quality and outcomes since the end of the 1990s, in large part facilitated by substantial real growth in health spending. Life expectancy had continued to increase: but health inequalities had proved stubbornly resistant to improvement.
Source: Marcus Longley, Neil Riley, Paul Davies, and Cristina Hernandes-Quevedo, United Kingdom (Wales): Health System Review, European Observatory on Health Systems and Policies
Links: Report
Date: 2012-Nov
A think-tank report said that the National Health Service was entering a period of significant risk that could jeopardize progress made over the previous decade. As unprecedented financial pressures started to bite, 'cracks were beginning to appear', with accident and emergency waiting times rising and more hospitals in financial difficulty. Major organizational changes and the loss of experienced managers left the service in a 'precarious' position.
Source: Sarah Gregory, Anna Dixon, and Chris Ham (eds), Health Policy under the Coalition Government: A mid-term assessment , King s Fund
Links: Report | Kings Fund press release | Labour Party press release | NHS Confederation press release | BBC report | Guardian report | Public Finance report
Date: 2012-Nov
A think-tank report examined the association between patients' perceptions of the non-clinical aspects of care by family doctors in England and measures of clinical quality. Generally speaking, practices that delivered a good experience for their patients had higher outcomes scores. With some exceptions, practices that performed poorly on both clinical outcome measures and patient experience were more likely to be located in London and in more deprived areas.
Source: Veena Raleigh and Francesca Frosini, Improving GP Services in England: Exploring the association between quality of care and the experience of patients , King s Fund
Links: Report | Kings Fund blog post | Guardian report
Date: 2012-Nov
An article examined how much the public said that they wanted choice in the provision of public services, and how far that was related to satisfaction with public services. Citizens said that they wanted choice, and the more they said that they wanted it the less satisfied they were with National Health Service hospital services. However, the claim that citizens valued choice for its own sake was also not supported. Public perceptions of how much choice people had over which hospital they attended were not associated with service satisfaction once perceptions of how much patients were involved in their treatment were taken into account.
Source: John Curtice and Oliver Heath, 'Does choice deliver? Public satisfaction with the health service', Political Studies, Volume 60 Issue 3
Links: Abstract
Date: 2012-Oct
The coalition government announced that medical revalidation – under which all doctors licensed with the General Medical Council (GMC) would have to show they were fit to practise – would start in December 2012. Revalidation would normally happen every 5 years. Doctors would also undergo annual appraisals based on the requirements of the GMC's core guidance on good medical practice.
Source: Written Ministerial Statement 19 October 2012, columns 39-40WS, House of Commons Hansard, TSO
Links: Hansard | DH press release | GMC press release | BMA press release | HPA press release | Labour Party press release | NHS Confederation press release | NHS Employers press release | RCGP press release | RCOG press release | RCP press release | BBC report | Guardian report
Date: 2012-Oct
A think-tank report highlighted the damaging financial and social cost of a 'litigation culture' for health and education. Far from increasing safety and accountability, the culture of litigation had resulted in significant costs in terms of the quality of services, the experience of those who used them, and the role of professionals. As at March 2011, the National Health Service Litigation Authority estimated its potential liabilities at £16.8 billion, of which £16.6 billion related to clinical negligence claims: but of the 63,800 claims for medical negligence made since 2001, only about 2,000 (3.2 per cent) had had damages approved or set by the courts.
Source: Frank Furedi and Jennie Bristow, The Social Cost of Litigation, Centre for Policy Studies
Links: Report | CPS press release | Kent University press release
Date: 2012-Sep
A report said that complaints about doctors had reached a record high, with patients more prepared to raise concerns about their treatment. The number of complaints to the General Medical Council (which oversees doctors' standards) increased by 23 per cent from 7,153 in 2010 to 8,781 in 2011 – continuing a rising trend seen since 2007.
Source: The State of Medical Education and Practice in the UK: 2012, General Medical Council
Links: Report | GMC press release | BMA press release | Labour Party press release | NHS Confederation press release
Date: 2012-Sep
An article examined the impacts of the performance framework for the National Health Service introduced in the late 1990s, by comparing the UK to other European Union countries. Citizen satisfaction and performance perceptions in the UK were more favourable after the reforms than they would have been without them.
Source: Ashley Grosso and Gregg Van Ryzin, 'Public management reform and citizen perceptions of the UK health system', International Review of Administrative Sciences, Volume 78 Number 3
Links: Abstract
Date: 2012-Sep
A chapter in the 2012 British Social Attitudes Survey report examined public attitudes to the National Health Service. Public satisfaction with the NHS had fallen sharply since a record high in 2010, although most people thought that the standard of healthcare had improved or stayed the same in the previous five years. People tended to think that the healthcare system needed to change: but there was little appetite for fundamental reform of the NHS.
Source: John Appleby and Lucy Lee, 'Health care in Britain: is there a problem and what needs to change?' (in Alison Park, Elizabeth Clery John Curtice, Miranda Phillips, and David Utting (eds), British Social Attitudes: The 29th Report), National Centre for Social Research
Links: Report | NatCen press release | Guardian report | Nursing Times report | Telegraph report
Date: 2012-Sep
The government began consultation on a new licensing regime for providers of National Health Service services. The issues included: who would be required to hold a licence from Monitor (the regulatory body); how providers could challenge proposed changes to licence conditions; and the maximum fine that Monitor could impose for breach of licence conditions.
Source: Protecting and Promoting Patients Interests Licensing Providers of NHS Services: A consultation on proposals, Department of Health
Links: Consultation document | DH press release
Date: 2012-Aug
The government began consultation on regulations designed to protect patients' interests by ensuring that National Health Service commissioners always delivered best value. It set out proposals for requirements to: act transparently, avoid discrimination, and purchase services from the providers best placed to meet patients' needs; enable patients to exercise their rights to choose as set out in the NHS Constitution; and manage conflicts of interest and ensure that particular interests did not influence their decision-making.
Source: Securing Best Value for NHS Patients: Requirements for commissioners to adhere to good procurement practice and protect patient choice, Department of Health
Links: Consultation document | DH press release
Date: 2012-Aug
An umbrella body for health service organizations responsible for standards began consultation on a report setting out how quality would be maintained and improved in the new health system. The report focused predominantly on how the new system should prevent, identify, and respond to serious failures in quality.
Source: Quality in the New Health System: Maintaining and improving quality from April 2013, National Quality Board
Links: Consultation document | DH press release
Notes: The National Quality Board brings together the national organizations across the health system responsible for quality, including: the Care Quality Commission, Monitor, the NHS Trust Development Authority, NICE, the General Medical Council, the Nursing and Midwifery Council, the NHS Commissioning Board Authority, and the Department of Health.
Date: 2012-Aug
A report said that National Health Service hospitals had substantial scope to improve their efficiency by adopting best practice – by tackling cases of 'inexplicable' higher costs or lengths of stay.
Source: James Gaughan, Anne Mason, Andrew Street, and Padraic Ward, English Hospitals Can Improve their Use of Resources: Analysis of costs and length of stay for ten treatments, Research Paper 78, Centre for Health Economics (University of York)
Links: Paper | York University press release
Date: 2012-Jul
A think-tank report examined how the system of quality assurance in the National Health Service needed to evolve, the principles on which it should be built, and how it should operate. The system needed to support the actions and effectiveness of those working at the front line, and of those who managed and led organizations that delivered care.
Source: Anna Dixon, Catherine Foot, and Tony Harrison, Preparing for the Francis Report: How to assure quality in the NHS, King s Fund
Links: Report
Date: 2012-Jul
The inspectorate for healthcare and social care published its annual report for 2011–12.
Source: Annual Report and Accounts 2011/12, HC 482, Care Quality Commission, TSO
Links: Report
Date: 2012-Jul
An article examined associations between the size of financial incentives and expected health gain in the 2004 and 2006 versions of the performance framework for family doctors (the 'Quality and Outcomes Framework'). No statistically significant associations were found between the expected health gain and the incentive gained from a marginal 1 per cent increase in performance. In addition, no associations were found between the size of financial payment for achievement of an indicator and the expected health gain at the performance threshold for maximum payment, measured in lives saved or quality-adjusted life years.
Source: Robert Fleetcroft, Nicholas Steel, Richard Cookson, Simon Walker, and Amanda Howe, 'Incentive payments are not related to expected health gain in the pay for performance scheme for UK primary care: cross-sectional analysis', BMC Health Services Research, Volume 12
Links: Abstract
Date: 2012-Jul
An article examined the impact of case-mix adjustment on family doctor performance scores in a national survey of patient experience. Although its effect was modest for most practices, case-mix adjustment corrected significant underestimation of scores for a small proportion of practices serving vulnerable patients. It might reduce the risk that providers would 'cream-skim' by not enrolling patients from vulnerable socio-demographic groups.
Source: Charlotte Paddison, Marc Elliott, Richard Parker, Laura Staetsky, Georgios Lyratzopoulos, John Campbell, and Martin Roland, 'Should measures of patient experience in primary care be adjusted for case mix? Evidence from the English General Practice Patient Survey', BMJ Quality & Safety, Volume 21 Issue 8
Links: Abstract
Date: 2012-Jul
The competition watchdog for the National Health Service published a paper highlighting the types of actions taken by hospital trusts facing competition that were likely to improve the quality of the patient's treatment.
Source: Chris Pike, Inside the Black Box: How competition between hospitals improves the quality and integration of services, Working Paper 5, Co-operation and Competition Panel for NHS-Funded Services
Links: Paper
Date: 2012-Jul
A watchdog report said that children and young people faced multiple barriers in making complaints about mental health and sexual health services in England. Complaints systems were too complicated, took too long, relied too much on written skills, and were overly formal. Staff in mental health, sexual health, and family doctor services were not trained to receive and act on complaints made by children and young people.
Source: Cathy Street, Yvonne Anderson, Brenda Allan, Adrienne Katz, Mary Webb, and Joe Roberson, 'It Takes a Lot of Courage', Office of the Children's Commissioner
Links: Report | OCC press release
Date: 2012-Jul
An audit report said that there were 'considerable variations' in the delivery of healthcare across the four nations of the United Kingdom, in areas such as health outcomes, spending, staffing, and quality.
Source: Healthcare Across the UK: A comparison of the NHS in England, Scotland, Wales and Northern Ireland, HC 192 (Session 2012-13), National Audit Office, TSO
Links: Report | NAO press release | Public Finance report | Telegraph report
Date: 2012-Jun
A report examined the views of children and young people on health provision. Children and young people saw their parents as playing a very important role in the management of their care: but they described 'being treated like I was stupid', being ignored, or being patronized during hospital stays.
Source: Ivana La Valle and Lisa Payne (with Jennifer Gibb and Helena Jelicic), Listening to Children's Views on Health Provision: A rapid review of the evidence, National Children s Bureau
Links: Report | NCB press release
Date: 2012-May
An article examined the impact of hospital mergers in England on a large set of outcomes including financial performance, productivity, waiting times, and clinical quality. There was little evidence that mergers achieved gains other than a reduction in activity. Given that mergers reduced the scope for competition between hospitals, the findings suggested that further merger activity might not be the appropriate way of dealing with poorly performing hospitals.
Source: Martin Gaynor, Mauro Laudicella, and Carol Propper, 'Can governments do it better? Merger mania and hospital outcomes in the English NHS', Journal of Health Economics, Volume 31 Issue 3
Links: Abstract
See also: Martin Gaynor, Mauro Laudicella, and Carol Propper, Can Governments Do It Better? Merger mania and hospital outcomes in the English NHS, Working Paper 12/281, Centre for Market and Public Organisation (University of Bristol)
Date: 2012-May
An article examined whether hospitals with a good organization of care (such as improved nurse staffing and work environments) could affect patient care and nurse workforce stability in European countries. The percentage of nurses reporting poor or fair quality of patient care varied substantially by country. Nurses with better work environments were half as likely to report poor or fair care quality and give their hospitals poor or failing grades on patient safety. Each additional patient per nurse increased the odds of nurses reporting poor or fair quality care, and poor or failing safety grades. Patients in hospitals with better work environments were more likely to rate their hospital highly and recommend their hospitals. Results were similar in the United States of America. Improvement of hospital work environments might be a relatively low-cost strategy to improve safety and quality in hospital care and to increase patient satisfaction.
Source: Linda Aiken, Walter Sermeus, Koen Van den Heede, Douglas Sloane, Reinhard Busse, Martin McKee, Luk Bruyneel, Anne Marie Rafferty, Peter Griffiths, Maria Teresa Moreno-Casbas, Carol Tishelman, Anne Scott, Tomasz Brzostek, Juha Kinnunen, Rene Schwendimann, Maud Heinen, Dimitris Zikos, Ingeborg Stromseng Sjetne, Herbert Smith, and Ann Kutney-Lee, 'Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States', British Medical Journal, 20 March 2012
Links: Article
Date: 2012-Apr
A study found that there had been a 'dramatic' increase in waiting times for surgical procedures by acute National Health Service trusts in England, and a decline in the number of operations being carried out. It said that the figures cast serious doubt on claims by the NHS that waiting times were falling, and highlighted the need for more transparency about waiting times in individual clinical areas.
Source: The Waiting Game, Patients Association
Links: Report | Patients Association press release | Labour Party press release | Guardian report | Telegraph report
Date: 2012-Apr
An article examined the impact of provider diversity on quality and innovation in the English National Health Service by identifying the differences in performance between third sector organizations (TSOs), for-profit private enterprises, and incumbent organizations within the NHS. Private providers showed greater concern to improve patient pathways and patient experience, whereas TSOs delivered quality improvements by using a more holistic approach and a greater degree of community involvement. There was scope to increase the participation of diverse providers: but care needed to be taken not to damage public accountability, overall productivity, equity, and NHS providers (especially acute hospitals).
Source: Pauline Allen, Simon Turner, Will Bartlett, Virginie Perotin, Greenwell Matchaya, and Bernarda Zamora, 'Provider diversity in the English NHS: a study of recent developments in four local health economies', Journal of Health Services Research and Policy, Volume 17 Supplement 1
Links: Abstract
Date: 2012-Mar
A report by a committee of MPs expressed concerns regarding the leadership and performance of the health and social care regulator for England (the Care Quality Commission).
Source: The Care Quality Commission: Regulating the Quality and Safety of Health and Adult Social Care, Seventy-eighth Report (Session 2010-12), HC 1779, House of Commons Public Accounts Select Committee, TSO
Links: Report | CQC press release | Kings Fund press release | RCN press release | BBC report | Guardian report
Date: 2012-Mar
An article examined which policy-relevant characteristics of healthcare systems contributed to health-system efficiency in developed (OECD) countries. Broader health-system structures, such as Beveridgian or Bismarckian financing arrangements or gatekeeping, were not significant determinants of efficiency. Significant contributors to efficiency were policy instruments that directly targeted patient behaviours, such as insurance coverage and cost sharing; and those that directly targeted physician behaviours, such as physician payment methods.
Source: Dominika Wranik, 'Healthcare policy tools as determinants of health-system efficiency: evidence from the OECD', Health Economics, Policy and Law, Volume 7 Issue 2
Links: Abstract
Date: 2012-Mar
A report published by the regulator for National Health Service foundation trusts said that the information underpinning the reimbursement system for service providers needed 'significant improvement'. There were unexplained variations between providers in the unit costs charged for the same services, and areas where data quality was 'poor'.
Source: PricewaterhouseCoopers LLP, An Evaluation of the Reimbursement System for NHS-Funded Care, Monitor
Links: Report | Monitor press release
Date: 2012-Mar
A think-tank report highlighted the way in which frail older people were being exposed to unacceptable standards of care and 'moved around from pillar to post' in hospital because of a lack of continuity of care.
Source: Jocelyn Cornwell, Ros Levenson, Lara Sonola, and Emmi Poteliakhoff, Continuity of Care for Older Hospital Patients: A Call for Action, King s Fund
Links: Report | Kings Fund press release | BBC report
Date: 2012-Mar
An article examined the reform under which more autonomy was given to better-performing National Health Service hospitals in England. Despite being enmeshed in a politicized culture of regulations and guidance, autonomy was increasingly perceived positively, and appeared to depend on the extent to which organizations had the incentives and the capacity to respond.
Source: Paul Anand, Mark Exworthy, Francesca Frosini, and Lorelei Jones, 'Autonomy and improved performance: lessons from an NHS policy reform', Public Money and Management, Volume 32 Issue 3
Links: Abstract
Date: 2012-Mar
Researchers estimated output, input, and productivity growth for the English National Health Service for the period 2003-04 to 2009-10. Over the full period increases in inputs had been matched closely by increases in output. There were, however, wide variations in productivity across the country: future efforts to improve productivity should be directed at reducing these variations.
Source: Chris Bojke, Adriana Castelli, Rosalind Goudie, Andrew Street, and Padraic Ward, Productivity of the English National Health Service 2003-4 to 2009-10, Research Paper 76, Centre for Health Economics (University of York)
Links: Paper | York University press release
Date: 2012-Mar
A report said that there was continued institutional discrimination in the National Health Service against people with a learning disability. Although some positive steps had been taken, many health professionals were still failing to provide adequate care. The report highlighted the deaths of 74 people with a learning disability in NHS care over the previous 10 years that were a direct result of institutional discrimination and could have been avoided.
Source: Death by Indifference: 74 deaths and counting – A progress report 5 years on, Mencap
Links: Report | Summary | Mencap press release
Date: 2012-Feb
The findings were published of a performance and capability review of the Care Quality Commission (the inspectorate for health and social services in England). The CQC had made 'considerable achievements' since it was established in 2009. It had delivered a challenging programme of work, and was increasing the number of inspections. But the scale of this task had been underestimated by CQC and the Department of Health, and more could have done more to manage risks during the early years of the organization's operation. The role of the CQC had not been as clear as it needed to be to health and care providers, patients, and the public.
Source: Performance and Capability Review: Care Quality Commission, Department of Health
Links: Report | Hansard | DH press release | MHF press release
Date: 2012-Feb
A paper examined the impact of competition from public sector and private sector hospitals on the efficiency of public hospitals. The results suggested that competition between public providers prompted public hospitals to improve their productivity by decreasing their pre-surgery, overall, and post-surgery length of stay. In contrast, competition from private hospitals did not spur public providers to improve their performance: instead it left incumbent public providers with a more costly case mix of patients, and led to increases in post-surgical average length of stay.
Source: Zack Cooper, Stephen Gibbons, Simon Jones, and Alistair McGuire, Does Competition Improve Public Hospitals Efficiency? Evidence from a quasi-experiment in the English National Health Service, DP1125, Centre for Economic Performance (London School of Economics)
Links: Paper | Guardian report | Public Finance report | Telegraph report
Date: 2012-Feb
An analysis found that hospital treatment in England was associated with improvements in health. Variability in treatment impact was generally more pronounced in respect of mobility, usual activity, and pain/discomfort than on others.
Source: Nils Gutacker, Chris Bojke, Silvio Daidone, Nancy Devlin, and Andrew Street, Analysing Hospital Variation in Health Outcome at the Level of EQ-5D Dimensions, Research Paper 74, Centre for Health Economics (University of York)
Links: Paper
Date: 2012-Jan
A paper said that mergers were unlikely to be the most effective way of dealing with poorly performing National Health Service hospitals. The wave of hospital consolidation in the late 1990s and early 2000s – in which around one-half of the acute hospitals in England had been involved in a merger – had brought few benefits.
Source: Martin Gaynor, Mauro Laudicella, and Carol Propper, Can Governments Do It Better? Merger mania and hospital outcomes in the English NHS, Working Paper 12/281, Centre for Market and Public Organisation (University of Bristol)
Links: Paper | Bristol University press release
Date: 2012-Jan
A review of hospital efficiency found that there were 'many ways' in which hospitals could improve efficiency and reduce the need for cutbacks in services for patients. It cited length of stay and day surgery rates as examples of where there were still opportunities for efficiency to be improved.
Source: Jeremy Hurst and Sally Williams, Can NHS Hospitals Do More with Less?, Nuffield Trust
Links: Report | Nuffield Trust press release | BBC report
Date: 2012-Jan