NHS vulnerable to serious lapses in care even as care quality improves in some areas, report warns

Ongoing pressures risk making the health service more vulnerable to serious lapses in care.


Press release

Published: 08/12/2016

Ongoing pressures on the NHS risk making the health service more vulnerable to serious lapses in care in future, despite impressive achievements in maintaining and improving care quality in important areas, the Nuffield Trust and Health Foundation warn today.

'Quality at a cost', the latest annual statement from the Nuffield Trust and Health Foundation’s QualityWatch programme, looks at a range of care quality measures across the NHS in England. The report highlights several areas of healthcare where standards have improved, but the authors point to slowing improvement in other areas, growing waiting times and continuing financial pressures as evidence that the NHS could face serious challenges in maintaining standards in care.

The report explains that the deterioration in waiting times we see now did not begin until some years into the current decade of austerity. Work by NHS staff to increase productivity and meet targets may have delayed the impact of financial pressures upon the quality of healthcare. The authors conclude that other areas of patient care may experience a similar delayed decline as the financial squeeze continues.

Key findings indicating improvements in healthcare quality include:

  • Improvements in some areas of public health and prevention, including childhood obesity at age 4-5 and reductions in smoking in pregnancy
  • Improvements in patients’ experience of hospital care, with 84 percent reporting they were treated with dignity and respect, compared to 80 percent in 2011
  • Improved processes in stroke care, including more patients than three years ago having brain scans within an hour, having their swallowing assessed, and having occupational therapy input into their rehabilitation.

Areas of concern include:

  • Growing waiting times for emergency and planned care, with nearly four in ten ambulances taking longer than eight minutes to reach life threatening emergencies in September 2016, and patients waiting a week longer to see a consultant in 2016 than in 2012
  • A slowdown in the progress towards eradicating some healthcare associated infections and an increase in the number and rate of less well monitored infections, which in combination with very high levels of bed occupancy, risks patient safety. For example, cases of E.coli increased by almost a fifth between 2012/13 and 2015/16
  • People with mental ill health reporting much lower rates of satisfaction for inpatient care than those without mental ill health in 2015.

Commenting on the research, lead author Dr Liz Fisher said:

“In the face of considerable pressures, our analysis shows that there are improvements to the quality of healthcare for patients that we should recognise and celebrate. These are even more impressive when understood in the context of growing demand for healthcare and the tightest funding settlement for decades. But elsewhere, in areas such as ambulance response times, the news isn’t so good. The next twelve months will prove a crucial test for the resilience of the health service.”

Nigel Edwards, Chief Executive of the Nuffield Trust said:

“The fact that the financial squeeze didn’t immediately affect the quality of patient care reflects the hard work and goodwill of NHS staff. But slowing improvement in some areas of quality, combined with longer waiting times and ongoing austerity suggests the NHS is heading for serious problems. It seems likely that a system under such immense pressure will be unable, at some point, in some services, to provide care to the standards that patients and staff alike expect.”

Dr Jennifer Dixon, Chief Executive of the Health Foundation said:

“More can be done to improve efficiency within the NHS, and ideas and innovative thinking to improve and transform services are in ample supply within the health service. But, the NHS needs a chance to deliver them through intelligent investment, support and time.”

Editors’ notes:

  • ‘Quality at a cost; QualityWatch annual statement 2016’ is the fourth QualityWatch annual statement from Nuffield Trust and the Health Foundation.
  • QualityWatch is a joint programme by the Nuffield Trust and Health Foundation providing independent scrutiny of health and social care quality data. The programme monitors over 300 care quality indicators, which are published on the QualityWatch website. It also publishes research reports, news and blogs about care quality and data.
  • The Nuffield Trust is an independent health policy think tank. We aim to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate.
  • The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. Our aim is a healthier population, supported by high quality health care.

Related documents: 


Appears in

2016: Quality at a cost

Annual Statement
  • 08/12/2016
  • Dr Elizabeth Fisher | Lucia Kossarova | Eilís Keeble | Holly Smith (Dorning) | Nora Cooke O'Dowd