The UK has become a world leader in pessimism about the future quality of its health care. A 2016 Ipsos MORI poll of 18,000 people in 23 countries found that British people were the least optimistic when asked about the quality of health care that they or their family would have access to over the next few years. Only 8% of people in the UK thought it would get better; 47% thought it would get worse, making people in the UK more pessimistic than those in 22 other countries, including Spain, Italy, France and Germany.

This worry is understandable. Public perceptions are likely to have been shaped by the intense media coverage of the human and financial pressures on the NHS in recent months and years. Paradoxically, a large majority of patients using care tend to be very satisfied, so how justified is this anxiety about the quality of NHS care in the future?

To help inform the debate ahead of the June 2017 general election, the Health Foundation is publishing three briefings on NHS and social care finances, the quality of care provided by the NHS, and the NHS and social care workforce. In the first briefing, we showed that funding in England since 2010 has not risen as quickly as the pressures on the NHS, which have been caused by having to meet the health care needs of a growing population, and the rising costs of staff, drugs and other essentials.

So what has happened to the quality of services over this period? Has it started to falter under the weight of the gap between static funding and rising pressures? In this second briefing, we give a very high level snapshot of how the quality of some NHS services has changed over the past few years in England.

A word about quality

  • Quality in health care is a broad concept and not easy to measure. It includes the compassion shown by staff to patients, whether the right tests and treatments were given for a specific illness, whether the treatment was given quickly enough and was safe, and whether the treatment did what it was expected to do in terms of improving a condition or curing an illness.
  • Health care is high quality if it is safe, effective, person-centred, timely, efficient and equitable. With millions of people using NHS services for thousands of different treatments and conditions, it is not possible to give a comprehensive picture of quality in England across all these dimensions.
  • National data mask variation in the quality of care between different parts of England: the Care Quality Commission (CQC), national clinical audits, NHS RightCare, My NHS, National General Practice Profiles and others all highlight large unwarranted variations within and between organisations, services and teams.
  • The Organisation for Economic Co-operation and Development (OECD) has also highlighted differences in aspects of quality between the four countries of the UK. In this briefing, we focus on England because health has been a devolved matter since the late 1990s, but some national clinical audits include the other countries of the UK, and we make international comparisons on a UK basis due to limits in the available information.